Post-transplant EBV-negative anaplastic large-cell lymphoma with dual rearrangement: a propos of two cases and review of the literature.

Abstract

BACKGROUND:

Post-transplant lymphoproliferative disease (PTLD) is a recognized complication of the immunosuppressive regimens associated with solid organ transplantation. The vast majority of these lesions represent monomorphic B-cell lymphoproliferative disease. Rarely, however, T-cell malignancies may emerge, the commonest being anaplastic large-cell lymphoma (ALCL).

MATERIALS AND METHODS:

We describe two patients who developed a post-transplant ALCL several years after transplantation. Comprehensive phenotypic and molecular studies were conducted. The technique of capillary gel electrophoresis was employed.

RESULTS:

One patient died of unrelated causes, while the other patient did achieve clinical remission. The neoplastic cell populace was composed of CD4-positive cytotoxic T cells exhibiting CD30 positivity. There were very few B cells. Striking and prominent clonally restricted infiltrates were identified whereby there was both a heavy chain and T-cell beta gene rearrangement. There was no evidence of lytic Epstein-Barr virus (EBV) infection.

CONCLUSION:

T-cell-associated PTLD does not appear to be directly attributable to EBV infection. Iatrogenic immune dysregulation may result in excessive T-cell proliferation to various antigenic stimuli, hence resembling other drug-associated cell lymphoproliferative conditions such as angioimmunoblastic lymphadenopathy. The dual rearrangement may have some implications regarding the cell of origin.

• Authors: Cynthia M Magro, David J Weinerman, Pierre Luigi Porcu, Carl D Morrison
• Journal: Journal of cutaneous pathology (J Cutan Pathol) Vol. 34 Suppl 1 Pg. 1-8 (Dec 2007) ISSN: 1600-0560 [Electronic] United States
• PMID: 17997729 (Publication Type: Case Reports, Journal Article)

Chemical References

• Antigens, CD
• DNA, Neoplasm
• Immunoglobulin Heavy Chains

Topics

• Adult
• Antigens, CD (metabolism)
• DNA, Neoplasm (analysis)
• Electrophoresis, Capillary
• Fatal Outcome
• Female
• Gene Rearrangement, B-Lymphocyte, Heavy Chain (genetics)
• Gene Rearrangement, beta-Chain T-Cell Antigen Receptor (genetics)
• Herpesvirus 4, Human (isolation & purification)
• Humans
• Immunocompromised Host
• Immunoglobulin Heavy Chains (genetics)
• Liver Transplantation (adverse effects)
• Lymphoma, Large-Cell, Anaplastic (genetics, pathology, virology)
• Male
• Middle Aged
• Postoperative Complications
• Remission Induction
• Skin Neoplasms (genetics, pathology, virology)