Elsevier

Human Pathology

Volume 32, Issue 11, November 2001, Pages 1264-1268
Human Pathology

Case Studies
Epstein-Barr virus–associated extranodal NK/T-cell lymphoma, nasal type of the hypopharynx, in a renal allograft recipient: Case report and review of literature*

https://doi.org/10.1053/hupa.2001.28962Get rights and content

Abstract

Posttransplant lymphoproliferative disorders (PTLPDs) are predominantly B-cell lymphoproliferations, whereas a T-cell origin is rarely observed. In contrast to B-cell PTLPD, T-cell PTLPDs show an inconsistent association with Epstein-Barr virus (EBV). Until now, only 13 cases of EBV-associated T-cell PTLPDs have been reported. We describe a case of an EBV-associated T-cell PTLPD in a renal allograft recipient 2 years after transplantation. Histologic examination showed medium- to large-sized lymphoid cells with an angiocentric growth pattern and necrosis. The atypical cells showed a CD2+, CD3ϵ+, CD7+, CD43+, CD45R0+, CD56+, and CD4−, CD5−, CD8− βF1- phenotype with expression of the latent membrane protein (LMP)-1 of EBV. In addition, EBV-specific RNAs (EBER 1/2) were identified by in situ hybridization. Molecular analysis of the T-cell receptor (TCR) γ chain by polymerase chain reaction (PCR) showed a polyclonal pattern. The morphologic, immunohistochemical, and molecular findings were consistent with a diagnosis of an EBV-associated extranodal natural killer (NK)/T-cell non-Hodgkin lymphoma (NHL) of nasal type. To our knowledge, this is the first reported case of this rare entity in the posttransplant setting. HUM PATHOL 32:1264-1268. Copyright © 2001 by W.B. Saunders Company

Section snippets

Case report

A 65-year-old male patient received a cadaveric kidney transplant in March 1996. A triple therapy consisting of cyclosporine A, prednisolone, and azathioprine was prescribed. In December 1997, he developed a small ulcer at the back of the pharynx. Clinical examination, serologic tests for EBV (including Epstein-Barr nuclear antigen [EBNA] and EBV early antigen [EA]) cytomegalovirus (CMV), Listeria, human immunodeficiency virus (HIV), human T-cell lymphotrophic virus type I (HTLV-1) and human

Material and methods

Histology and immunohistochemistry was performed on formalin-fixed, paraffin-embedded sections from the pharyngeal tumor biopsy specimen. The primary antibodies used are listed in Table 1.Detection of EBV-specific RNAs (EBER 1/2) was performed by in situ hybridization as previously described.1 Briefly, after overnight hybridization at 42°C, the bound probe was detected with the alkaline phosphatase/anti-alkaline phosphatase technique and color development by using Fast Red substrate (Sigma,

Results

The hypopharyngeal biopsy specimen showed a partly necrotic tumor composed of a diffuse infiltrate of markedly pleomorphic medium- to large-sized lymphoid cells with irregularly shaped nuclei, dispersed, partly condensed chromatin, and prominent nucleoli. Occasional mitotic figures were noted. Remarkably, the neoplastic infiltrate showed a prominent angiocentricity (Fig 1), areas of geographic necrosis, and multifocal perineural expansion with infiltration of nerve sheats.

. Section of the

Discussion

In the present report, we describe a case of an EBV-associated NK/T-cell lymphoma of nasal type that ocurred in the hypopharynx of a renal transplant recipient. Morphologically, a destructive infiltrate of atypical, medium-sized to large cells with necrosis and marked angiocentricity was present. The neoplastic cells were positive for CD2, cytoplasmic CD3, CD7, CD43, CD45R0, and CD56. By PCR analysis, the tumor cells lacked a clonal rearrangement of the TCR γ-chain, consistent with a true

Acknowledgements

The authors thank Ms Evelyn Gredler for her assistance in molecular methods, Ms Sabine Jöbstl for excellent technical assistence in immunohistochemistry, and Ms Leticia Quintanilla-Martinez, MD, for critically reading the manuscript and for providing unpublished data.

References (18)

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*

Address correspondence and reprint requests to Stephan Dirnhofer, MD, Department of Pathology, University of Basel, Medical School, Schönbeinstrasse 40, CH-4003 Basel, Switzerland.

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