An Unusual Posttransplant T-cell Lymphoma After Liver Transplantation: A Case Report.
Citation: Transplantation Proceedings. 49(7):1639-1643, 2017 SepPMID: 28838455Institution: MedStar Washington Hospital CenterDepartment: PathologyForm of publication: Journal ArticleMedline article type(s): Journal ArticleSubject headings: *Graft vs Host Disease/co [Complications] | *Liver Transplantation/ae [Adverse Effects] | *Lymphoma, T-Cell/im [Immunology] | *Natural Killer T-Cells/im [Immunology] | *Postoperative Complications/im [Immunology] | Antineoplastic Agents/tu [Therapeutic Use] | Humans | Lymphoma, T-Cell/dt [Drug Therapy] | Male | Middle Aged | Postoperative Complications/dt [Drug Therapy]Year: 2017Local holdings: Available online from MWHC library: 1997 - present, Available in print through MWHC library:1999-2007ISSN:- 0041-1345
Item type | Current library | Collection | Call number | Status | Date due | Barcode |
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Journal Article | MedStar Authors Catalog | Article | 28838455 | Available | 28838455 |
Available online from MWHC library: 1997 - present, Available in print through MWHC library:1999-2007
Posttransplantation lymphoproliferative disorders (PTLDs) encompass a spectrum of heterogeneous entities ranging from benign lymphocytic proliferations to high-grade malignant lymphomas. The majority of PTLDs are associated with reactivation of Epstein-Barr virus (EBV), which induces B-cell proliferation and occurs in the setting of severe immune suppression after solid organ or bone marrow transplantation. T-cell/natural killer cell PTLDs are relatively rare, constituting ~15% of all cases. T-cell PTLDs are usually aggressive, and outcomes are poor. This article describes an unusual case of T-cell PTLD with a favorable outcome. The patient is a 57-year-old man who underwent a liver transplantation due to hepatitis C cirrhosis. He developed graft-versus-host disease with skin and gastrointestinal involvement and generalized lymphadenopathy 4 months after transplantation. Histologic sections of an excised axillary lymph node showed atypical medium and larger T-lymphocytes that were positive for CD3, CD5, CD43, and CD8 but were negative for B-cell antigens, CD56, and in situ hybridization for EBV-encoded RNA. Polymerase chain reaction analysis revealed monoclonal T-cell receptor gamma chain gene rearrangement. A diagnosis of high-grade T-cell PTLD was made. The patient was treated with 4 cycles of cyclophosphamide, doxorubicin, vincristine, and prednisone and is currently in remission, 4 years after therapy. The rapid presentation of an EBV-negative T-cell PTLD with a nonaggressive course and complete response to treatment is an unusual presentation of posttransplantation T-cell lymphoma, which is usually associated with a high mortality rate. Copyright (c) 2017 Elsevier Inc. All rights reserved.
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