Monoclonality of lymphoproliferative lesions in cardiac-transplant recipients. Clonal analysis based on immunoglobulin-gene rearrangements.
Whether lymphoproliferative disorders arising in immunosuppressed recipients of organ transplants are primarily neoplastic or hyperplastic in nature is a matter of controversy. Reports of polyclonal B-cell proliferations in these lesions suggest the presence of hyperplasia, but these disorders resemble lymphoma histologically and are clinically aggressive and often rapidly fatal, as expected of a malignant neoplastic disease. We examined tissue specimens from 10 cases of lymphoproliferative disease that occurred in immunosuppressed recipients of cardiac transplants. Specimens from nine of these patients lacked cellular immunoglobulin; however, analysis of DNA extracted from these tissues revealed that each lesion contained large numbers of cells possessing uniform, clonal rearrangements of immunoglobulin-gene DNA. Therefore, when first seen clinically these proliferations contained a notable monoclonal-cell population typical of conventional B-cell lymphomas that are not associated with immunosuppression. We therefore suggest that lymphoproliferative disorders in recipients of cardiac transplants are neoplastic at the earliest stages of detectable disease.
D000293:Adolescent; D000328:Adult; D001402:B-Lymphocytes; D002999:Clone Cells; D004247:DNA / Q000032:analysis; D003937:Diagnosis, Differential; D005260:Female; D016027:Heart Transplantation; D006801:Humans; D007136:Immunoglobulins / Q000235:genetics*; D007165:Immunosuppression Therapy / Q000009:adverse effects; D008223:Lymphoma / Q000175:diagnosis / Q000209:etiology / Q000473:pathology; D008232:Lymphoproliferative Disorders / Q000209:etiology* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications
D007136:Immunoglobulins; D004247:DNA