Ziarkiewicz-Wróblewska B, Górnicka B, Gierej B, Suleiman W, Nowacka-Cieciura E, Durlik M, Bogdańska M, Wasiutyński A, Pileri S A
Department of Pathology, Medical University of Warsaw, Warszawa.
Pol J Pathol. 2008;59(1):63-9.
We report the atypical case of posttransplant lymphoproliferative disorder (PTLD) diagnosed in 55-year men 9 years after renal transplantation. It was evaluated only by bone marrow biopsy, which showed its total involvement with malignant lymphoma. It was composed of two populations of lymphoid cells: large RS-like cells and small to medium ones, with slightly angular nuclei without visible nucleoli. Both cellpopulations did not show positive reaction for typical B cell markers (CD20, CD79a). Large RS-like cells were positive with CD30 and EBV-LMP. However, negative reaction with CD15 and positive reactions with UCHL1 and EMA were not consistent with classical type of Hodgkin lymphoma. Morphological picture and immunophenotype had suggested anaplastic T cell lymphoma. Because of negative reaction with ALK1, initial diagnosis was ALCL ALK-negative. Then, additional stains with BOB1 and Oct2 were performed, which were positive. Taking it into account the diagnosis was changed; finally Hodgkin-like B lymphoma was diagnosed. The patient was treated with CHOP regimen with good response. 5 years after primary diagnose of PTLD he is steel free of disease.
我们报告了一例非典型的移植后淋巴细胞增生性疾病（PTLD），该病例发生在一名55岁男性肾移植9年后。仅通过骨髓活检进行评估，结果显示其完全被恶性淋巴瘤累及。它由两类淋巴细胞组成：大的里-施（RS）样细胞和小到中等大小的细胞，细胞核略呈角形，无可见核仁。这两类细胞对典型的B细胞标志物（CD20、CD79a）均未显示阳性反应。大的RS样细胞CD30和EBV-LMP呈阳性。然而，CD15阴性反应以及UCHL1和EMA阳性反应与经典型霍奇金淋巴瘤不符。形态学表现和免疫表型提示为间变性T细胞淋巴瘤。由于ALK1阴性反应，初步诊断为ALK阴性的间变性大细胞淋巴瘤（ALCL）。随后进行了BOB1和Oct2的额外染色，结果呈阳性。综合考虑后诊断发生了改变；最终诊断为霍奇金样B淋巴瘤。该患者接受了CHOP方案治疗，反应良好。PTLD初次诊断5年后，他仍无疾病。
