The clinical spectrum, pathology, and clonal analysis of Epstein-Barr virus-associated lymphoproliferative disorders in heart-lung transplant recipients.
This study presents the clinical and laboratory observations on posttransplant lymphoproliferative disorders (PTLDs) occurring in 5 of 53 heart-lung transplantation recipients. Cervical lymph nodes, tonsils, lungs, and gastrointestinal tract were the common sites of involvement by PTLDs. The histopathologic findings showed a spectrum of lymphoid and immunoblastic proliferation ranging from diffuse hyperplasia to malignant lymphoma, immunoblastic or large cell type. All cases were associated with a primary Epstein-Barr virus infection, and viral DNA was demonstrated within the lesional tissue in three cases. Immunohistochemical and immunoglobulin gene rearrangement studies revealed a B-cell proliferation that was monoclonal in three cases and polyclonal in two cases. Compared with PTLDs arising in other organ transplant recipients, this series is remarkable for a high incidence of PTLDs (9.4%), a short interval to tumor diagnosis (2.2 months, mean), involvement of the primary allograft in three cases (60%), and the frequent development of bronchiolitis obliterans. Possible reasons for this distinct clinicopathologic profile are discussed.
Randhawa
P S
PS
Department of Pathology, University of Pittsburgh School of Medicine, Pennsylvania.
Yousem
S A
SA
Paradis
I L
IL
Dauber
J A
JA
Griffith
B P
BP
Locker
J
J
D000293:Adolescent; D000328:Adult; D001402:B-Lymphocytes / Q000276:immunology / Q000473:pathology; D002675:Child, Preschool; D005260:Female; D006084:Graft Rejection; D016027:Heart Transplantation; D016041:Heart-Lung Transplantation; D004854:Herpesvirus 4, Human / Q000302:isolation & purification; D006801:Humans; D016040:Lung Transplantation; D008213:Lymphocyte Activation; D008232:Lymphoproliferative Disorders / Q000276:immunology / Q000473:pathology*; D008297:Male; D011183:Postoperative Complications / Q000473:pathology*; D014412:Tumor Virus Infections / Q000276:immunology / Q000473:pathology*