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Lymphoma - Non B cell neoplasms
Post-transplantation lymphoproliferative disorders - Other
Reviewer: Nat Pernick, M.D. (see Reviewers page)
Revised: 30 October 2011, last major update September 2011
Copyright: (c) 2001-2011, PathologyOutlines.com, Inc.
Post-transplant anaplastic large cell lymphoma
Case reports
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● 14 year old boy with EBV+ anaplastic large T cell lymphoma 14 years after cardiac transplant (Am J Surg Pathol 2004;28:410)
● 68 year old woman with EBV- tumor post-heart/liver transplant (Arch Pathol Lab Med 2003;127:349)
Micro images
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Gastric tumor post-heart/liver transplant
Post-transplant Burkitt lymphoma
Clinical features
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● 5 cases reported (4 men, 1 woman, mean 35 years old, Am J Surg Pathol 2003;27:818)
● Interval averaged 4.5 years
● Presents with high stage disease with generalized lymphadenopathy and bone marrow involvement
Treatment
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● Rituximab or combination chemotherapy led to complete remission
Micro description
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● Burkitt or Burkitt-like morphology with monomorphic intermediate sized tumor cells with a small rim of basophilic cytoplasm, round nuclei and multiple small nuclei, also many tingible-body macrophages giving a typical starry sky pattern
● Touch preparations show deeply basophilic cytoplasm with numerous vacuoles
● Atypical (Burkitt-like) cases have more variability in size and shape
Molecular description
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● C-myc rearrangement, EBV
Post-transplant diffuse large B cell lymphoma
Clinical features
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● Common histologic type of post-transplant monomorphic lymphoma
Case reports
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● 61 year old post liver transplantation (Arch Pathol Lab Med 2003;127:248)
Micro images
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1-CT with multiple liver lesions; 2-diffuse liver involvement by large cells with prominent nucleoli; 3-CD20+; 4-EBV+; pleomorphic atypical lymphoid cells; CD20+
Post-transplant histiocytic sarcoma
Micro images
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Cells with large, irregular nuclei (figure 3)
Positive stains
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● CD68, granzyme B
Post-transplant Hodgkin lymphoma
Clinical features
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● Uncommon type of PTLD
● Most often post renal transplantation
● Almost always EBV+
● CD30+, CD15+ (CD15- cases may exist), CD45-, CD20-
● Rare cases may follow other types of PTLD
Micro description
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● Plasma cells, lymphocytes and eosinophils mixed with Reed-Sternberg or similar appearing cells
Positive stains
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● Reed-Sternberg cells - EBV EBER1 by ISH, CD15, CD30, fascin
Negative stains
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● CD45
Molecular description
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● No immunoglobulin gene rearrangements
Post-transplant Hodgkin’s lymphoma-like lymphoproliferative disorder
Description
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● Very rare
● Cases to date involve males, often teenagers
● Similar to Hodgkin lymphoma, but with atypical phenotype
● Nodal or extranodal
● Appears to be a type of B cell post-transplant lymphoproliferative disorder (Arch Pathol Lab Med 2006;130:558)
Treatment
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● Reduce immunosuppression, variable chemotherapy or radiation therapy
Micro description
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● Small to medium lymphoid cells mixed with Reed-Sternberg like cells (large, mono- bi or multinucleated); also histiocytes, plasma cells and rare eosinophils
Micro images
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Reed-Sternberg like-cells are CD30+ (inset), but also CD45+ and CD15- (figure 4)
Positive stains
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● Reed-Sternberg like cells: CD45, CD20, CD79a, EBER; variable CD30; lymphoid cells are B/T cells and often EBER+
Negative expression
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● CD15
Molecular description
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● Immunoglobulin gene rearrangements
Post-transplant MALT-type extranodal marginal zone lymphomas
Clinical features
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● Rare, 5 cases reported at Am J Surg Pathol 2000;24:100
● Mean age 51 years (range, 48-63 years); after heart, liver, kidney transplants; involves stomach (H. pylori+) and parotid gland
● Occurs average 7 years post-transplant
● All tumors reported above were low-grade MALT, EBV negative, non-aggressive
Post-transplant myeloma
Clinical features
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● Rare; 3 cases reported resemble conventional myeloma (Mod Pathol 2004;17:389)
Micro images
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Various images
Post-transplant NK/T cell lymphoproliferative disorders
Clinical features
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● Rare, <100 cases reported; most post-transplant lymphoproliferative disorders are B cell origin
● 20% are associated with Epstein-Barr virus
Case reports of extranodal NK/T cell lymphoma, nasal-type
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● Tumor of hypopharynx in renal transplant recipient (Hum Pathol 2001;32:1264)
● 20 year old woman with EBV+ breast tumor (Mod Pathol 2004;17:125)
Micro description
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● Angiocentric growth of medium to large lymphoid cells with necrosis
Micro images
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Breast tumor after heart transplant
Post-transplant T cell lymphoma of bone marrow
Case reports
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● T-cell large granular lymphocytosis (Am J Clin Pathol 2005;123:196)
Micro description
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● Focal or extensive interstitial involvement of large cells with abundant cytoplasm and prominent nucleoli
● Cellular debris is prominent
● Reduced normal hematopoiesis
● May be difficult to identify without special stains
Positive stains
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● CD2, CD3
End of Lymphoma - Non B cell neoplasms > Post-transplantation lymphoproliferative disorders - Other
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