Lymphoma & related disorders

Posttransplant lymphoproliferative disorders (PTLD)

PTLD-infectious mononucleosis

Last author update: 1 August 2011
Last staff update: 29 December 2020

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PubMed Search: Infectious mononucleosis PTLD

Dragos C. Luca, M.D.
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Cite this page: Luca DC. PTLD-infectious mononucleosis. website. Accessed August 17th, 2022.
Definition / general
  • Lymphoid proliferations in an allograft recipient, characterized by architectural preservation of the involved tissue, with preservation of the nodal sinuses or tonsillar crypts, and residual and sometimes floridly reactive follicles, usually forming mass lesions (WHO Classification, 2008)
  • Must exclude other lymphoid proliferations or nonspecific inflammatory processes
Clinical features
  • Younger age than other PTLD, often in solid organs with no prior EBV infection
  • Involves lymph nodes and tonsils / adenoids more often than extranodal sites
  • Frequent spontaneous regression or regression after reduction of immunosuppression
  • Poly or mono PTLD may follow; IM-like cases may be fatal
Microscopic (histologic) description
  • Plasmacytic hyperplasia: numerous plasma cells, small lymphocytes, occasional immunoblasts
  • IM-like: paracortical expansion, numerous immunoblasts, background of T cells and plasma cells, normal architecture may be partially destroyed
  • Florid follicular hyperplasia may also occur; criteria not well defined to distinguish from reactive follicular hyperplasia
Microscopic (histologic) images

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IM-like PTLD (Multiple images, H&E and IHC)

  • Polyclonal B cells, plasma cells and T cells with no aberrant biomarkers
  • EBV positive (EBV LMP1): most plasmcytic hyperplasia and florid follicular hyperplasia cases, and virtually all IM-like cases
Molecular / cytogenetics description
  • No clonal rearrangements of the Ig genes
  • Small mono or oligoclonal populations may be detected in IM-like lesions
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