Post-transplant lymphoproliferative disorder

Case contributed by Dr Bruno Di Muzio

Presentation

1-year post left lung transplant.

Patient Data

Age: 65 years
Gender: Female

There are plaques of pleural thickening with at least two solid pleural based mass lesions involving the lower aspects of the left hemithorax. Bilateral small pleural effusions. Severe changes of emphysema involving the right native lung. 

Nuclear medicine

PET-CT shows increased uptake within the pleural masses in the left hemithorax. 

Case Discussion

The pleural mass lesions have been biopsied:

Macroscopy: Pale tan tissue with an area of grey shiny serosal surface inked green and bisected.

Microscopy:  The biopsy consists of a nodule of highly cellular and partly necrotic malignant tumour within a fibrous connective tissue. The tumour is composed of a sheetlike proliferation of fairly uniform large cells that have hyperchromatic nuclei with occasional prominent nucleoli and a small amount of cytoplasm. Mitotic figures and apoptotic bodies are frequent. There are patches of intratumoural necrosis.

Immunoperoxidase stains:

  • Positive: CD20, MUM1 (20%), BCL2, CD30 (patchy and non-uniform), EBV-LMP
  • Negative: CD10, CD5, BCL6, cyclinD1, AE1/3, S100

Conclusion:  Left pleural tissue biopsy: Diffuse large B cell lymphoma, EBV+ (monomorphic post-transplant lymphoproliferative disorder).

 

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Case information

rID: 58509
Published: 22nd Feb 2018
Last edited: 16th Jul 2018
System: Chest
Inclusion in quiz mode: Included

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