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.
Hoffmann
H
H
Department of Pathology, University of Texas, Houston, USA.
Schlette
E
E
Actor
J
J
Medeiros
L J
LJ
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