title: Post cardiac transplantation T-cell lymphoproliferative disorder presenting as a solitary lung nodule.
abstract: Post-transplantation lymphoproliferative disorder (PTLD) is an infrequent, but serious complication of solid organ and bone marrow transplantations. The vast majority of the cases are of B-cell origin and usually associated with Epstein-Barr virus (EBV) infection. The non-B (T and NK cell) PTLDs account for up to 14% of the PTLD cases in Western countries. We report a case of a 66-year-old man who received an orthotopic heart transplant for cardiomyopathy 7 years prior to presentation. He was referred to our institution with a hypermetabolic solitary right lower lobe lung nodule with an SUV of 9.2 on PET scan. The combined histomorphological and immunohistochemical pattern was most consistent with monomorphic PTLD, peripheral T-cell lymphoma with angioimmunoblastic features. Molecular studies showed clonal T-cell gamma receptor gene rearrangement. Primary pulmonary involvement of T-cell PTLD is extremely rare. This is the third reported case of T-cell PTLD after cardiac transplantation, primarily involving the lung. Further, studies will be required to determine the appropriate treatment and prognosis of this rare entity.
authors.affiliation: Department of Pathology & Immunology, Baylor College of Medicine Houston, Texas, USA.
authors.forename: Barina
authors.initials: B
authors.lastname: Aqil
authors.forename: Bhuvaneswari
authors.initials: B
authors.lastname: Krishnan
authors.forename: Choladda V
authors.initials: CV
authors.lastname: Curry
authors.forename: M Tarek
authors.initials: MT
authors.lastname: Elghetany
authors.forename: Reka
authors.initials: R
authors.lastname: Szigeti
mesh_terms: D000368:Aged; D014408:Biomarkers, Tumor / Q000032:analysis / Q000235:genetics; D001706:Biopsy; D015334:Gene Rearrangement, gamma-Chain T-Cell Antigen Receptor; D016027:Heart Transplantation / Q000009:adverse effects*; D006801:Humans; D007150:Immunohistochemistry; D008175:Lung Neoplasms / Q000737:chemistry / Q000175:diagnosis / Q000209:etiology* / Q000235:genetics / Q000276:immunology / Q000601:surgery; D016411:Lymphoma, T-Cell, Peripheral / Q000737:chemistry / Q000175:diagnosis / Q000209:etiology* / Q000235:genetics / Q000276:immunology / Q000601:surgery; D008297:Male; D011013:Pneumonectomy; D049268:Positron-Emission Tomography; D003074:Solitary Pulmonary Nodule / Q000737:chemistry / Q000175:diagnosis / Q000209:etiology* / Q000235:genetics / Q000276:immunology / Q000601:surgery
chemical_list: D014408:Biomarkers, Tumor
keywords: PTLD; T-cell lymphoma; heart transplantation; lung nodule