Post cardiac transplantation T-cell lymphoproliferative disorder presenting as a solitary lung nodule

Abstract

Post-transplantation lymphoproliferative disorder (PTLD) is an infrequent, but serious complication of solid organ and bone marrow transplantations. The vast majority of the cases are of B-cell origin and usually associated with Epstein-Barr virus (EBV) infection. The non-B (T and NK cell) PTLDs account for up to 14% of the PTLD cases in Western countries. We report a case of a 66-year-old man who received an orthotopic heart transplant for cardiomyopathy 7 years prior to presentation. He was referred to our institution with a hypermetabolic solitary right lower lobe lung nodule with an SUV of 9.2 on PET scan. The combined histomorphological and immunohistochemical pattern was most consistent with monomorphic PTLD, peripheral T-cell lymphoma with angioimmunoblastic features. Molecular studies showed clonal T-cell gamma receptor gene rearrangement. Primary pulmonary involvement of T-cell PTLD is extremely rare. This is the third reported case of T-cell PTLD after cardiac transplantation, primarily involving the lung. Further, studies will be required to determine the appropriate treatment and prognosis of this rare entity.

Keywords: PTLD; T-cell lymphoma; heart transplantation; lung nodule.

Figure 1

Gross photograph of infiltrating tan white nodule in the lobectomy specimen.

Figure 2

Monotonous proliferation of lymphocytes invading the bronchial epithelium and the lung parenchyma (A). Higher magnification showing diffuse infiltration of atypical small lymphocytes with irregular nuclei (B). CD3 immunohistochemical stain showing the majority of the cells are of T-cell lineage (C). CD20 immunostain highlights scattered B-lymphocytes (D).