Pleural posttransplantation lymphoproliferative disorder following liver transplantation.
A case of posttransplantation lymphoproliferative disorder (PTLD) involving the pleura is reported. The patient was a 57-year-old man who underwent liver transplantation 2 years prior to the development of PTLD. The PTLD was pleural-based and was first detected by radiologic studies as a pleural effusion. Transbronchial biopsy and cytologic examination of 2 pleural fluid specimens were nondiagnostic. Subsequent open-wedge biopsy revealed a monomorphic PTLD, composed of large immunoblasts with plasmacytoid differentiation. Immunohistochemical studies demonstrated B-cell lineage with expression of monotypic cytoplasmic immunoglobulin kappa light chain and CD79a, and absence of T-cell antigens. Immunohistochemical and in situ hybridization studies demonstrated Epstein-Barr virus protein and RNA, respectively. No evidence of human herpesvirus 8 DNA was detected by polymerase chain reaction. We report this case because pleural-based PTLD is rare. The diagnosis of this entity is made more difficult by the fact that PTLD is often underrepresented in pleural fluid cytology samples.
Department of Pathology, University of Texas, Houston, USA.
H
H
Hoffmann
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E
Schlette
J
J
Actor
L J
LJ
Medeiros
D020031:Epstein-Barr Virus Infections / Q000150:complications / Q000473:pathology; D017809:Fatal Outcome; D004854:Herpesvirus 4, Human / Q000235:genetics / Q000302:isolation & purification; D006801:Humans; D007150:Immunohistochemistry; D017403:In Situ Hybridization; D016031:Liver Transplantation / Q000009:adverse effects*; D008232:Lymphoproliferative Disorders / Q000473:pathology* / Q000821:virology; D008297:Male; D008875:Middle Aged; D010995:Pleural Diseases / Q000473:pathology* / Q000821:virology; D010996:Pleural Effusion / Q000473:pathology / Q000821:virology; D011183:Postoperative Complications / Q000473:pathology*; D012367:RNA, Viral / Q000032:analysis; D016601:RNA-Binding Proteins / Q000032:analysis; D012269:Ribosomal Proteins
D012367:RNA, Viral; D016601:RNA-Binding Proteins; D012269:Ribosomal Proteins; C067169:RPL22 protein, human