Lymphoma and plasma cell neoplasms
Posttransplantation lymphoproliferative disorders (PTLD)
WHO Classification

Author: Dragos Luca, M.D. (see Authors page)

Revised: 22 March 2017, last major update September 2011

Copyright: (c) 2002-2017, PathologyOutlines.com, Inc.

PubMed Search: WHO Classification PTLD

Cite this page: WHO Classification of posttransplant lymphoproliferative disorders. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/lymphomanonBposttranswho.html. Accessed March 29th, 2017.
WHO Classification
  • Early Lesions
    • Some mass-like lesions in the posttransplant setting may have the morphologic appearance of florid follicular hyperplasia or other marked but noninfectious mononucleosis-like lymphoid hyperplasias;
    • Plasmacytic hyperplasia
    • Infectious mononucleosis-like lesion
  • Polymorphic PTLD
    • ICD-O codes for these lesions are the same as those for the respective lymphoid or plasmacytic neoplasm
  • Monomorphic PTLD
    • B cell neoplasms
      • Diffuse large B cell lymphoma
      • Burkitt lymphoma
      • Plasma cell myeloma
      • Plasmacytoma-like lesion
      • Note: Indolent small B cell lymphomas arising in transplant recipients are not included among the PTLD
    • T cell neoplasms
      • Peripheral T cell lymphoma, NOS
      • Hepatosplenic T cell lymphoma
      • Other
  • Classical Hodgkin lymphoma type PTLD
Diagrams / Tables
Pathologic evaluation of speciments for the diagnosis of PTLD
(from WHO Classification of Tumours of Haematopoietic and Lymphoid Tissues, 4th Edition, Lyon 2008)

Method of evaluation

Necessity

Purpose

Histopathology

Essential

Evaluate architecture and cytologic features, required for classification


Immunophenotype

Essential

Assess possible light chain class restriction* and basic lymphoid subsets, required for classification


EBER-ISH

Essential**

Most sensitive method for assessing if PTLD is EBV positive, aids in diagnosis and possibly prognostication, useful in differential diagnosis with rejection in allograft (if positive)


Genetic/Cytogenetic studies

Variable

Determine clonality, lineage of clonal population(s), chromosomal and oncogene abnormalities, may be needed for classification


EBV clonality

Not required

Identification of minor clones


*Paraffin section immunohistochemistry will often fail to demonstrate monotypic B cell populations, even if present, unless there is plasmacytic differentiation

**If the less sensitive EBV LMP1 stain is positive, EBER-ISH is not required



Pathologic evaluation of speciments for the diagnosis of PTLD
(from WHO Classification of Tumours of Haematopoietic and Lymphoid Tissues, 4th Edition, Lyon 2008)

Pathologic category

Histopathology

Immunophenotype in situ hybridization

Genetics

Architectural effacement

Major findings

[email protected]

Other abnormalities

Early lesions

Absent

Small lymphocytes, plasma cells, +/- immunoblasts, +/- hyperplastic follicles

Pcl B cells & admixed T cells; often EBV+

Pcl or very small mcl B cell population(s)

None

Polymorphic PTLD

Present

Full spectrum of lymphoid maturation seen

Pcl or mcl B cells & admixed T cells; often EBV+

Mcl B cells, non-clonal T cells

Some have bcl6 somatic hypermutations

Monomorphic PTLD

Usually present

Fulfills criteria for a NHL (other than one of the indolent B cell neoplasms) or plasma cell neoplasm

Varies based on type of neoplasm they resemble. EBV more variable than in other categories

Clonal B cells and/or T cells (except for rare NK cases)

Usually present

Hodgkin lymphoma type PTLD

Present

Fulfils criteria for CHL

Similar to other CHL; EBV+

IgH will not be easily demonstrated

Not known

Pcl, polyclonal; Mcl, monoclonal; NK, natural killer; TCR, T cell antigen receptor.

Notes
  • According to some authors, MALT lymphomas should be considered M-PTLD: may be EBV+ and may regress after reduction in immunosuppression
  • PTLD at relapse may differ from initial PTLD in morphology, EBV status and lineage
  • B cell and T cell PTLD can occur in the same patient; most commonly B precedes T but simultaneous or vice versa also possible