Post-transplant T-cell lymphoma in pleural fluid cytology: a case report

Abstract

<h3>Background</h3> Post-transplant lymphoproliferative disorders (PTLD) are a heterogeneous group of lymphoid proliferations of varying clonal composition secondary to immunosuppression in solid-organ transplant. Most commonly are of B-cell in origin; T-cell lymphomas are rare (15% of all PTLD). <h3>Case presentation</h3> A 75-year-old man with 15-year post-heart transplant for dilated cardiomyopathy presented with a large left-sided pleural effusion. Pleural fluid cytology was highly cellular and contained dispersed large malignant cells having small to moderate amount of granular cytoplasm with pleomorphic nuclei and prominent nucleoli; many cells had multiple chromocentres; some were binucleate. Occasional mitoses and apoptotic bodies were present. Phenotypically, cells were positive for CD3, CD30, and EMA but negative for CD4, CD8, CD5 and CD7. They were negative for ALK and EBV markers. Flow cytometry showed positivity for T-cell and NK-cell markers (CD2, CD3, CD7, CD56, CD57 and TCR). <h3>Discussion</h3> Only a few cases of post-transplant T-cell lymphoma have been described in literature. To our knowledge, this is the first reported case of an ALK and EBV negative anaplastic T-cell lymphoma in pleural fluid cytology following cardiac transplant. Similar to B-cells proliferation, they have a predilection for skin, abdomen and pleura; only a minority are associated with EBV infection, in contrast to B-cells proliferation. The prognosis is generally poor.