title: Unusual peripheral T cell lymphoma presenting as acute liver failure and reappearing in the liver allograft.
abstract: A 25-year-old man presented with fulminant hepatic failure from an unusual peripheral T cell lymphoma involving the liver and spleen without lymphadenopathy. He underwent liver transplantation before establishing a definitive diagnosis and 21 days later, died from liver allograft failure because of recurrent lymphoma. In both the native liver and hepatic allograft, the lymphoma presented as a sparse cytologically atypical malignant infiltrate intermixed with numerous reactive macrophages, which showed marked angio- and epitheliotropism and irregular areas of coagulative necrosis. The malignant cells were CD3+/ granzyme B+/TIA1+/CD8-/CD56-/S100-- with variable staining for beta F1, CD5, and CD7. Multiplex polymerase chain reaction (PCR) showed rearrangement of the T cell receptor gamma chain gene in the native and transplanted liver and spleen. Even in the absence of a mass lesion or lymphadenopathy, peripheral T cell lymphoma should be included in the differential diagnosis of fulminant hepatic failure in young patients who show no evidence of viral or autoimmune diseases.
authors.affiliation: Thomas E. Starzl Transplantation Institute, Department of Pathology, University of Pittsburgh Medical Center, PA 15261, USA.
authors.forename: K
authors.initials: K
authors.lastname: Blakolmer
authors.forename: P
authors.initials: P
authors.lastname: Gaulard
authors.forename: C
authors.initials: C
authors.lastname: Mannhalter
authors.forename: S
authors.initials: S
authors.lastname: Swerdlow
authors.forename: L R
authors.initials: LR
authors.lastname: Fassati
authors.forename: G
authors.initials: G
authors.lastname: Rossi
authors.forename: U
authors.initials: U
authors.lastname: Maggi
authors.forename: D
authors.initials: D
authors.lastname: Conte
authors.forename: A J
authors.initials: AJ
authors.lastname: Demetris
mesh_terms: D000328:Adult; D003937:Diagnosis, Differential; D015334:Gene Rearrangement, gamma-Chain T-Cell Antigen Receptor; D006801:Humans; D007150:Immunohistochemistry; D017114:Liver Failure, Acute / Q000175:diagnosis* / Q000209:etiology*; D008113:Liver Neoplasms / Q000150:complications / Q000175:diagnosis* / Q000473:pathology; D016031:Liver Transplantation / Q000009:adverse effects / Q000473:pathology; D016399:Lymphoma, T-Cell / Q000150:complications / Q000175:diagnosis* / Q000473:pathology; D008297:Male; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis* / Q000473:pathology; D014184:Transplantation, Homologous