Posttransplant lymphoproliferative disorders: a clinicopathological analysis of 11 cases

Abstract

Objective To analyze the clinicopathological features of the posttransplant lymphoproliferative disorders (PTLD) and to improve the diagnostic levels. Methods The clinical data of 11 patients diagnosed with PTLD between January 2008 and January 2018 from Henan Provincial People's Hospital, Peking University Science Center and the Affiliated Third Hospital of Peking University were collected. The clinicopathological features and the potential prognostic predictors were retrospectively analyzed by using immunohistochemical staining, EB virus in situ hybridization, fluorescence in situ hybridization and gene sequencing. Results There were 9 males and 2 females in 11 PTLD patients, and the median age of the total patients was 18 years old (3-34 years old). The median time of 9 cases who underwent hematopoietic stem cell transplantation developing PTLD was 4 months (2-24 months) after the transplantation. The other 2 cases undergoing solid organ transplantation (SOT) occurred PTLD after 6 months and 13 months, respectively. The lymph node was the most common site to be involved (9 cases), 1 case occurred in liver and 1 case occurred in nasopharynx site. Among 11 patients, 3 cases were classified as polymorphic PTLD (P-PTLD) and the other 8 cases were monomorphic PTLD (M-PTLD). EB virus of all cases was positive, and 8 cases of M-PTLD were classified as diffuse large B-cell lymphoma (DLBCL). Fluorescence in situ hybridization was used to detect bcl-2, myc, IGH and A20 gene, and only one case had the gene break of IGH, while other cases didn't find any other abnormalities. Ig gene clone analysis was made in 5 patients with PTLD, including 4 cases of M-PTLD with gene rearrangement and 1 case of P-PTLD without gene rearrangement. Univariate analysis showed that age (≤18 years old) was associated with poor prognosis (P = 0.040). Conclusions The clinicopathologic features of PTLD are various and infected by EB virus. Gene rearrangement can help the diagnosis. Key words: Lymphoproliferative disorders; Transplantation; Herpesvirus 4, human; Pathology, clinical