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. 2012 Jun;3(6):1203-1206.
doi: 10.3892/ol.2012.670. Epub 2012 Apr 3.

Epstein-Barr virus-associated lymphoproliferative disorder developed following autologous peripheral blood stem cell transplantation for relapsing Hodgkin's lymphoma

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Epstein-Barr virus-associated lymphoproliferative disorder developed following autologous peripheral blood stem cell transplantation for relapsing Hodgkin's lymphoma

Sakura Izumiya et al. Oncol Lett. 2012 Jun.

Abstract

Post-transplant lymphoproliferative disorders (PTLDs) are lymphoid or plasmacytic proliferations that develop as a consequence of immunosuppression in a recipient of a solid organ, bone marrow or stem cell allograft. The development of PTLDs is usually associated with Epstein-Barr virus (EBV) and the disorder is also termed EBV-associated lymphoproliferative disorder (LPD). The development of PTLD is a rare complication in autologous bone marrow/peripheral blood stem cell transplantation. In the present study, we report a case of EBV-associated LPD which developed following autologous peripheral blood stem cell transplantation for relapsing Hodgkin's lymphoma. A 51-year-old male presented with swelling of the left cervical lymph nodes. A biopsy revealed nodular sclerosis classical Hodgkin's lymphoma. Following four courses of ABVd (adriamycin, bleomycin, vinblastine, dacarbazine) therapy, the Hodgkin's lymphoma relapsed. CHASE (cyclophosphamide, etoposide, cytarabine, dexamethasone) therapy and autologous peripheral blood stem cell transplantation were performed. In the 128 days following the transplantation, lymph node swelling was noted and a biopsy specimen demonstrated EBV-associated LPD. The serum copy number of EBV-DNA was 2.7×10(3) copies/ml. The occurrence of EBV-associated LPD may be on the rise due to the increased number of patients undergoing immunosuppression therapy. The measurement of the serum EBV-DNA copy number and the detection of EBV-infected atypical lymphocytes using in situ hybridization are significant in establishing an early accurate diagnosis and initiating the correct treatment for EBV-associated LPD in patients with immunosuppression.

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Figures

Figure 1
Figure 1
Computed tomography and positron emission tomography. (A) Computed tomography scan showing swelling of the left cervical lymph nodes (arrow). (B) Positron emission tomography scan showing accumulation in the left cervical and mesenteric lymph nodes (arrows).
Figure 2
Figure 2
Histopathological findings of the first biopsy of the cervical lymph node. Sclerotic fibrous tissue divides the lymph node into nodules and a number of atypical large lymphocytes are present in the nodules. Numerous lacuna and Hodgkin’s cells are present and occasionally Reed-Sternberg cells are also observed (inset). Hematoxylin and eosin stain; original magnification, ×40 (inset, ×200).
Figure 3
Figure 3
Immunohistochemical and in situ hybridization findings of the first biopsy of the cervical lymph node. Large atypical lymphocytes are positive for CD15 and CD30, but no EBER-positive atypical lymphocytes are present (original magnification, ×400). EBER, EBV-encoded early RNA.
Figure 4
Figure 4
Histopathological findings of the inguinal lymph node biopsy. Atypical large lymphocytes with prominent nucleoli are scattered among numerous small to medium-sized lymphocytes (arrows). Hematoxylin and eosin stain; original magnification, ×100.
Figure 5
Figure 5
Immunohistochemical and in situ hybridization findings of the inguinal lymph node biopsy. CD20 and EBER are expressed in the atypical large lymphocytes. Small lymphocytes are positive for CD8. Original magnification, ×40 (CD8); ×100 (CD20, EBER). EBER, EBV-encoded early RNA.

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