Lymphoma & related disorders

Posttransplant lymphoproliferative disorders (PTLD)


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

Copyright: 2002-2022,, Inc.

PubMed Search: Monomorphic PTLD

Dragos C. Luca, M.D.
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Cite this page: Luca DC. PTLD-monomorphic. website. Accessed August 17th, 2022.
Definition / general
  • Fulfill the criteria for one of the B cell or NK/T cell neoplasms recognized in the immunocompetent host (WHO Classification of Tumours of Haematopoietic and Lymphoid Tissues, 4th Edition, Lyon 2008)
  • Exception: small B cell lymphoid neoplasms (follicular lymphoma, MALT) not designated as a posttransplantation lymphoproliferative disorder (PTLD)
  • Monomorphic PTLD (M-PTLD) should be diagnosed as a PTLD and further subclassified based on the WHO lymphoma classification (e.g., posttransplant lymphoproliferative disorder, diffuse large B cell lymphoma type)
  • Monoclonal transformed B lymphocytic or plasmacytic proliferations that fulfill the criteria for a diffuse large B cell lymphoma, less often a Burkitt lymphoma or a plasma cell neoplasm (Haematologica 2011;96:1067)
Clinical features
  • Similar to B cell lymphomas and plasma cell neoplasms in immunocompetent individuals
Case reports
Microscopic (histologic) description
  • Fulfill criteria for conventional diffuse large B cell lymphoma, Burkitt lymphoma, myeloma or plasmacytoma
  • Lack the full range of maturation seen in polymorphic PTLD
  • Significant pleomorphism may be present; monomorphic does not mean complete cellular monotony
Microscopic (histologic) images

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EBV+ tumor cells in transplant patient

  • Nonplasmacytic lesions: CD19+, CD20+, CD79a+, PAX5+, monotypic Ig (often γ or α heavy chain), CD30+ (many)
  • Most M-PTLD are of nongerminal center type, based on immunohistochemistry
  • EBV+ cases: CD10-, bcl6+/-, IRF4 / MUM1 +, CD138-/+ (late / post GC phenotype)
  • EBV- cases: CD10+/-, BCL6+, IRF4 / MUM1-, CD138- (GC phenotype)
Molecular / cytogenetics description
  • Clonal Ig gene rearrangements in virtually all cases
  • EBV genomes in clonal episomal form
  • Somatic mutations of IGV
  • RAS, TP53, MYC, bcl6 anomalies
  • Cytogenetic abnormalities: 1q11-q21, 8q24.1, 3q27, 16p13, 14q32, 11q23-24, +9, +11, +7, +X, +2, +12
  • EBV PTLD: often lack expression of CDKN2A
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