Post-transplant lymphoproliferative disorders in kidney transplantation: histological and molecular genetic assessment.
We performed histopathological and immunohistochemical studies, in situ hybridization (ISH) for Epstein-Barr virus (EBV) and molecular genetic analysis using the PCR method for the immunoglobulin heavy chain gene in six patients with post-transplant lymphoproliferative disorders (PTLD) to clarify these problems. In two patients, PTLD developed in the graft, and in the remaining four it developed in systemic lymphoid tissues or organs. In terms of morphological classification, lesions in the graft of two patients were polymorphic with features of rejection in the background. In the other four patients, three of them presented monomorphic lesions and the remaining one presented features of reactive lymphoid hyperplasia. All the patients were positive for EBV as determined by ISH. The molecular genetic study could be performed for four patients, the cells in lesions of two patients were found to be monoclonal and those of the remaining two were polyclonal in IgH as determined by PCR. We conclude that PTLD are of two types, namely, intragraft PTLD and extra-graft PTLD. In the cases of intragraft PTLD their diagnosis is relatively difficult, because lesions are mixed with features of rejection. Molecular genetic analysis and detection of EBV by ISH are useful for diagnosis. In contrast, the diagnosis of extra-graft PTLD is easier than that of intragraft PTLD, by basing of the latest classification of malignant lymphoma. Grading of severity of PTLD should be carried out according to the newest system and protocols for treatment based on the grade of the lesion should be established as soon as possible.
Koike
Junki
J
Department of Pathology, St Marianna University, School of Medicine, Kawasaki, Japan. j2koike@marianna-u.ac.jp
Yamaguchi
Yutaka
Y
Hoshikawa
Masahiro
M
Takahashi
Hiroko
H
Horita
Shigeru
S
Tanabe
Kazunari
K
Fuchinoue
Shohei
S
Toma
Hiroshi
H
Nihei
Hiroshi
H
D000293:Adolescent; D000328:Adult; D002648:Child; D005260:Female; D004854:Herpesvirus 4, Human / Q000235:genetics; D006801:Humans; D007143:Immunoglobulin Heavy Chains / Q000235:genetics; D007150:Immunohistochemistry; D017403:In Situ Hybridization; D007668:Kidney / Q000473:pathology; D016030:Kidney Transplantation; D008232:Lymphoproliferative Disorders / Q000209:etiology / Q000235:genetics* / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D016133:Polymerase Chain Reaction; D011183:Postoperative Complications
D007143:Immunoglobulin Heavy Chains