T-cell lymphoma after heart transplantation.
A 26-year-old woman who had undergone orthotopic heart transplantation because of dilative cardiomyopathy received a triple-drug immunosuppressive regimen (cyclosporine A, azathioprine, and prednisolone). During her relatively frequent episodes of acute rejection, she was treated with methylprednisolone and repeated application of ATG. A short time before the patient's death, a fine-needle aspiration of the liver revealed the cytologic diagnosis of a malignant pleomorphic medium-size cell non-Hodgkin's lymphoma of a higher grade of malignancy. Immunosuppression was reduced, and the patient died in cardiogenic shock related to a histologically confirmed episode of severe acute rejection 264 days after the transplantation. On autopsy, the malignant lymphoma previously diagnosed by fine-needle aspiration cytology was found to be present in the liver as the only extranodal localization. The immunohistologic analysis of the immunophenotype specified the lymphomatous neoplasia as a T-cell lymphoma. The particular importance of this case is that it is, to our knowledge, the third case of proven T-cell lymphoma following organ grafting documented in the literature and the first case described in a cardiac allograft recipient.
Department of Thoracic and Cardiovascular Surgery, Hannover Medical School, Lower Saxony, Federal Republic of Germany.
J
J
Kemnitz
J
J
Cremer
M
M
Gebel
A
A
Uysal
A
A
Haverich
A
A
Georgii
D000328:Adult; D005260:Female; D016027:Heart Transplantation / Q000009:adverse effects*; D006801:Humans; D007124:Immunoenzyme Techniques; D007165:Immunosuppression Therapy; D008113:Liver Neoplasms / Q000209:etiology* / Q000235:genetics / Q000378:metabolism / Q000473:pathology; D008228:Lymphoma, Non-Hodgkin / Q000209:etiology* / Q000235:genetics / Q000378:metabolism / Q000473:pathology; D009693:Nucleic Acid Hybridization; D010641:Phenotype; D013601:T-Lymphocytes / Q000276:immunology / Q000378:metabolism