Massive pseudolymphomatous pericardial effusion in the posttransplant setting mimicking posttransplant lymphoproliferative disease.
We report an unusual case of massive pseudolymphomatous pericardial effusion in a cardiac transplant recipient. The near-coincidental development of the lymphocytic effusion and an EBV-associated tonsillar lymphoproliferative disorder suggested that the effusion was a manifestation of a posttransplant B cell lymphoproliferative disorder (PTLD). Although benign pericardial effusion is frequently seen in the post-cardiac transplant setting, EBV-related PTLD may also present as a malignant lymphocytic effusion. We present detailed histologic, virologic, and immunophenotypic data that proved useful in distinguishing between these 2 processes. Whereas the tonsillar process was a potentially malignant EBV-positive B cell predominant process requiring immunosuppressant withdrawal, the pericardial effusion was a benign EBV-negative T cell predominant process that, given its association with rejection, might require the diametrically opposite therapy of increased immunosuppression. Our approach to the proper diagnostic distinction between these 2 different post-cardiac transplant processes should prove useful to cardiac transplant teams.
Hudnall
S D
SD
Department of Pathology, University of Texas Medical Branch, Galveston, Texas, USA.
Melez
K
K
Galindo
A
A
Bryson
Y
Y
D001402:B-Lymphocytes / Q000473:pathology; D001483:Base Sequence; D002675:Child, Preschool; D003937:Diagnosis, Differential; D016027:Heart Transplantation / Q000009:adverse effects*; D006801:Humans; D008232:Lymphoproliferative Disorders / Q000175:diagnosis* / Q000209:etiology* / Q000473:pathology; D008297:Male; D008969:Molecular Sequence Data; D010490:Pericardial Effusion / Q000175:diagnosis* / Q000209:etiology* / Q000473:pathology