Unusual peripheral T cell lymphoma presenting as acute liver failure and reappearing in the liver allograft.
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.
Blakolmer
K
K
Thomas E. Starzl Transplantation Institute, Department of Pathology, University of Pittsburgh Medical Center, PA 15261, USA.
Gaulard
P
P
Mannhalter
C
C
Swerdlow
S
S
Fassati
L R
LR
Rossi
G
G
Maggi
U
U
Conte
D
D
Demetris
A J
AJ
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