Post-transplant lymphoproliferative disorder

Case contributed by Bruno Di Muzio
Diagnosis certain


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 tumor within a fibrous connective tissue. The tumor 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 intratumoral 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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