Late Epstein-Barr virus infection of a hepatosplenic gamma delta T-cell lymphoma arising in a kidney transplant recipient.
OBJECTIVE
gd T-cell lymphomas are only exceptionally observed in transplanted patients. Aim of this study was the detailed characterization of one such case.


METHODS
The patient developed spontaneous splenic rupture six years after kidney transplantation. The splenic red pulp was infiltrated by medium-sized and large lymphoid cells with two or more nucleoli. At autopsy, similar lymphoid cells infiltrated the hepatic sinusoids. Histologic, immunologic and molecular studies were carried out.


RESULTS
By immunohistochemistry, the atypical lymphoid cells were found to express CD3, CD45 and CD43, indicating their T-lineage origin. Approximately 99% of spleen mononuclear cells (MNC) were CD3(+), gammadelta TcR+, CD4-, CD8-, alphabeta TcR-. A clonal gammadelta TcR rearrangement (Vgamma1-Jgamma1.3/2.3-Cgamma2; Vdelta1-Ddelta2-Jdelta1) was detected. The final diagnosis was peripheral T-cell lymphoma, hepato-splenic gammadelta-type. EBV infection of spleen MNC was documented by molecular studies. However, in situ hybridization for EBER-1 (EBV-RNA) showed that only a minority of malignant lymphoid cells (5-7%) were EBV-infected.


CONCLUSIONS
It is concluded that EBV infection was as a late event involving an already transformed gd T-cell clone.
Roncella
S
S
Servizio di Immunologia Clinica, Istituto Nazionale per la Ricerca sul Cancro, Genova, Italy.
Cutrona
G
G
Truini
M
M
Airoldi
I
I
Pezzolo
A
A
Valetto
A
A
Di Martino
D
D
Dadati
P
P
De Rossi
A
A
Ulivi
M
M
Fontana
I
I
Nocera
A
A
Valente
U
U
Ferrarini
M
M
Pistoia
V
V
D000328:Adult; D015703:Antigens, CD; D017252:CD3 Complex / Q000097:blood*; D019070:Cell Lineage; D004279:DNA, Viral / Q000097:blood; D020031:Epstein-Barr Virus Infections / Q000097:blood* / Q000235:genetics; D016694:Gene Rearrangement, delta-Chain T-Cell Antigen Receptor / Q000235:genetics; D006801:Humans; D016030:Kidney Transplantation / Q000276:immunology*; D017493:Leukocyte Common Antigens / Q000097:blood; D051917:Leukosialin; D008113:Liver Neoplasms / Q000276:immunology / Q000473:pathology* / Q000821:virology; D016399:Lymphoma, T-Cell / Q000145:classification* / Q000276:immunology* / Q000821:virology; D008297:Male; D016692:Receptors, Antigen, T-Cell, gamma-delta / Q000097:blood; D012795:Sialoglycoproteins / Q000097:blood; D013160:Splenic Neoplasms / Q000276:immunology / Q000473:pathology* / Q000821:virology
D015703:Antigens, CD; D017252:CD3 Complex; D004279:DNA, Viral; D051917:Leukosialin; D016692:Receptors, Antigen, T-Cell, gamma-delta; C465014:SPN protein, human; D012795:Sialoglycoproteins; D017493:Leukocyte Common Antigens