La Fortune Kristin, Zhang Dahua, Raca Gordana, Ranheim Erik A
Department of Pathology, University of Virginia School of Medicine, Charlottesville, VA 22908, USA.
Case Rep Hematol. 2013;2013:386147. doi: 10.1155/2013/386147. Epub 2013 May 7.
Posttransplant lymphoproliferative disorder (PTLD) comprises a spectrum ranging from polyclonal hyperplasia to aggressive monoclonal lymphomas. The majority of PTLDs are of B-cell origin while T-cell PTLDs and Hodgkin lymphoma-like PTLDs are uncommon. Here, we report a unique case of a 56-year-old man in whom a lymphoma with two distinct components developed as a duodenal mass seventeen years following a combined kidney-pancreas transplant. This PTLD, which has features not previously reported in the literature, consisted of one component of CD20 positive and EBV negative monomorphic diffuse large B-cell lymphoma. The other component showed anaplastic morphology, expressed some but not all T-cell markers, failed to express most B-cell markers except for PAX5, and was diffusely EBV positive. Possible etiologies for this peculiar constellation of findings are discussed and the literature reviewed for "composite-like" lymphomas late in the posttransplant setting.
移植后淋巴细胞增生性疾病（PTLD）包括从多克隆增生到侵袭性单克隆淋巴瘤的一系列病变。大多数PTLD起源于B细胞，而T细胞PTLD和霍奇金淋巴瘤样PTLD并不常见。在此，我们报告一例独特病例，一名56岁男性在肾胰联合移植17年后，十二指肠出现一个具有两种不同成分的淋巴瘤肿块。这种PTLD具有文献中此前未报道的特征，由一个CD20阳性且EBV阴性的单形性弥漫大B细胞淋巴瘤成分和另一个成分组成。另一个成分表现出间变性形态，表达部分但并非所有T细胞标志物，除PAX5外大多数B细胞标志物未表达，且弥漫性EBV阳性。本文讨论了这一特殊发现组合的可能病因，并对移植后期“复合型”淋巴瘤的文献进行了综述。
