title: Lymphoma resembling Hodgkin disease after posttransplant lymphoproliferative disorder in a liver transplant recipient.
abstract: BACKGROUND
  Posttransplant Epstein-Barr virus (EBV)-associated lymphoproliferative disorders (PTLD) are B-cell derived tumors of polymorphic to monomorphic histologic type. Hodgkin disease (HD) is not considered part of this spectrum and rarely occurs in the post-transplant population. A liver allograft recipient is reported who had a PTLD develop that resolved after a reduction of immunosuppression. Several years later, the patient had a separate lymphoid tumor develop that resembled HD. The relationship between the two proliferations is analyzed.
  
  
  METHODS
  Specimens were analyzed for T- and B-cell rearrangements and EBV status by Southern blot hybridization. Immunoperoxidase studies were performed to determine the phenotypic status of the lesions. In situ hybridization for EBV early RNA (EBER) was done to determine the distribution of virus-positive cells in tissue sections.
  
  
  RESULTS
  Unique clonal rearrangements of immunoglobulin genes and EBV were seen in each instance. No evidence of T-cell receptor rearrangement was observed. EBER positivity was widespread in the PTLD and largely, but not exclusively, limited to the anaplastic cell in the HD-like tumor. The phenotype of these anaplastic cells was similar to that described for Reed-Sternberg (RS) cells.
  
  
  CONCLUSIONS
  The two tumors are unique B-cell growths associated with separate clones of lymphocytes carrying episomal EBV. Patients with PTLD may be at risk for the continued development of EBV-associated disorders. Lymphomas resembling HD represent one possible manifestation of this risk.
authors.affiliation: Division of Transplantation Pathology, University of Pittsburgh School of Medicine, Pennsylvania.
authors.forename: M A
authors.initials: MA
authors.lastname: Nalesnik
authors.forename: P
authors.initials: P
authors.lastname: Randhawa
authors.forename: A J
authors.initials: AJ
authors.lastname: Demetris
authors.forename: A
authors.initials: A
authors.lastname: Casavilla
authors.forename: J J
authors.initials: JJ
authors.lastname: Fung
authors.forename: J
authors.initials: J
authors.lastname: Locker
mesh_terms: D000328:Adult; D015139:Blotting, Southern; D003937:Diagnosis, Differential; D005260:Female; D004854:Herpesvirus 4, Human / Q000302:isolation & purification*; D006689:Hodgkin Disease / Q000175:diagnosis; D006801:Humans; D007124:Immunoenzyme Techniques; D016130:Immunophenotyping; D017403:In Situ Hybridization; D016031:Liver Transplantation; D008223:Lymphoma / Q000175:diagnosis* / Q000209:etiology* / Q000276:immunology; D008232:Lymphoproliferative Disorders / Q000209:etiology* / Q000276:immunology; D011183:Postoperative Complications; D014412:Tumor Virus Infections / Q000209:etiology* / Q000276:immunology