title: EBV-positive low-grade marginal zone lymphoma in the breast with massive amyloid deposition arising in a heart transplant patient: A report of an unusual case.
abstract: According to the 2008 World Health Organization classification, low-grade lymphomas arising in transplant recipients are not considered as specific types of PTLD. Most such cases are not associated with EBV infections, although rare reports of post-transplant marginal zone lymphoma have been described. We describe the case of an 18-yr-old female with history of heart transplant who developed a breast mass, but was otherwise completely asymptomatic. Surgical excision of the mass and histopathologic examination showed a low-grade B-cell lymphoma most consistent with marginal zone lymphoma with massive amyloid deposition; furthermore, numerous tumor cells were positive for EBV by in situ hybridization for EBV-encoded RNA. The patient was treated with reduction in immunosuppression, and no additional lesions developed. This case describes an atypical presentation of post-transplant low-grade B-cell lymphoma, unusual in its location, histopathologic features, and association with EBV, thereby adding to the rare previous accounts of such an entity, suggesting the need to include post-transplant marginal zone lymphomas in the current classification of PTLD, and helping in determining the optimal treatment modalities for such tumors.
authors.affiliation: Department of Pathology, Medstar Georgetown University Hospital, Washington, DC 20007, USA.
authors.forename: Samer
authors.initials: S
authors.lastname: Nassif
authors.forename: Metin
authors.initials: M
authors.lastname: Ozdemirli
mesh_terms: D000293:Adolescent; D000682:Amyloid / Q000378:metabolism; D001943:Breast Neoplasms / Q000150:complications / Q000821:virology*; D020031:Epstein-Barr Virus Infections / Q000150:complications*; D005260:Female; D006333:Heart Failure / Q000150:complications / Q000628:therapy / Q000821:virology*; D016027:Heart Transplantation / Q000009:adverse effects*; D004854:Herpesvirus 4, Human; D006801:Humans; D007150:Immunohistochemistry; D007166:Immunosuppressive Agents / Q000009:adverse effects; D017403:In Situ Hybridization; D018442:Lymphoma, B-Cell, Marginal Zone / Q000150:complications / Q000821:virology*; D011183:Postoperative Complications; D012367:RNA, Viral / Q000032:analysis
chemical_list: D000682:Amyloid; D007166:Immunosuppressive Agents; D012367:RNA, Viral
keywords: Epstein-Barr virus; breast; lymphoproliferative disorder; transplant