title: T-cell acute lymphoblastic leukemia after liver transplant.
abstract: T-cell posttransplant lymphoproliferative disorders after solid-organ transplant are rare and may be clinically aggressive. A 3-year-old boy had liver transplant from his grandfather because of hepatoblastoma. The immunosuppressive regimen was based on tacrolimus and prednisolone. At 22 months after transplant (age, 5 years), the patient presented to the hospital because of severe cough. Computed tomography scan of the chest showed a large left mediastinal mass (9 × 7.2 × 7 cm) and left pleural effusion. A Tru-Cut biopsy of the mediastinal mass showed diffuse infiltration with blast cells, and the diagnosis of T-cell acute lymphoblastic leukemia was made. Immunohistochemical examination of blasts showed strong and diffuse terminal deoxynucleotidyl transferase and CD3 antibody expression; Ki-67 proliferation index was > 95%, and tumor cells were negative for Epstein-Barr virus. Tacrolimus was stopped, sirolimus was started, and chemotherapy was given, but he died 2 months after diagnosis because of chemotherapy-induced sepsis. Monomorphic T-cell posttransplant lymphoproliferative disorder with features of acute lymphoblastic leukemia and lymphoblastic lymphoma is rare after liver transplant.
authors.affiliation: Department of Pathology, Baskent University Faculty of Medicine, Ankara, Turkey.
authors.forename: Eylem
authors.initials: E
authors.lastname: Akar Özkan
authors.forename: B Handan
authors.initials: BH
authors.lastname: Özdemir
authors.forename: Eda
authors.initials: E
authors.lastname: Yılmaz Akçay
authors.forename: Alev
authors.initials: A
authors.lastname: Ok Atılgan
authors.forename: Mehmet
authors.initials: M
authors.lastname: Haberal
mesh_terms: D000970:Antineoplastic Agents / Q000009:adverse effects; D001706:Biopsy; D002675:Child, Preschool; D017809:Fatal Outcome; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects; D016031:Liver Transplantation / Q000009:adverse effects*; D019520:Living Donors; D008297:Male; D054218:Precursor T-Cell Lymphoblastic Leukemia-Lymphoma / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D018805:Sepsis / Q000139:chemically induced; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents; D007166:Immunosuppressive Agents