PTLD


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  • Clinical

    • risk: EBV negative pre-transplant
    • lung, intestinal transplants have > 5% risk
    • increased risk for marrow transplants: HLA mismatch, selective T cell depletion of donor marrow, antithymocyte globulin, anti CD3 monoclonal antibodies
    • etiology: decreased T cell immune surveillance
    • most due to EBV
    • donor origin (marrow), host origin (90% of solid organ transplants)
    • site: nodes, extranodal sites, frequently the allograft in solid organ transplants (except heart), early lesions involve tonsils/adenoids, rare in CNS
    • onset: within 6 mo (marrow), 1 yr (solid organ)

  • Types

    • Nondestructive/Early lesions (usually nodes, tonsils, adenoids, polytypic, lack effacement)
      • florid follicular hyperplasia: EBV+/-
      • plasmacytic hyperplasia: EBV+, lymphoplasmacytic
      • infectious mononucleosis: EBV+, lots of immunoblasts
    • polymorphic PTLD (effacement+, monotypic+/-)
      • most common PTLD in children, EBV association
      • polymorphic composition: immunoblasts, plasma cells, lymphoid cells (mixed B and T)
      • can have necrosis, RS cells (CD30+/CD15-), numerous mitosis
      • can have lymphoid aggregates in marrow
    • monomorphic PTLD (lymphoma)
      • DLBCL
      • Burkitt
      • plasma cell myeloma
      • plasmacytoma like lesion
      • EBV+ MALToma
      • T neoplasms
      • FL, CLL and EBV negative MALTomas are not considered PTLD
    • classical Hodgkin lymphoma PTLD
      • rare, mostly in renal transplants
      • EBV+
      • RS cells that are CD30+ and CD15+
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