Lymphoma & related disorders


WHO classification-PTLD

Last author update: 1 September 2011
Last staff update: 9 November 2020

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PubMed Search: WHO Classification PTLD

Dragos C. Luca, M.D.
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Cite this page: Luca D. WHO classification-PTLD. website. Accessed December 9th, 2022.
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, 2008)

Method of evaluation





Evaluate architecture and cytologic features, required for classification



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



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


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, 2008)

Pathologic category


Immunophenotype in situ hybridization


Architectural effacement

Major findings


Other abnormalities

Early lesions


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

Pcl B cells & admixed T cells; often EBV+

Pcl or very small mcl B cell population(s)


Polymorphic PTLD


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


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.

  • 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
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