Posttransplant lymphoproliferative disorders (PTLD) are a rare, but serious complication following transplantation. Late-onset PTLD are often associated with more monoclonal lesions and consequently have a worse prognosis. There are only isolated case reports of Burkitt’s lymphoma presenting as PTLD. We present an extremely rare, aggressive Burkitt’s lymphoma years after kidney and pancreas transplantation which was successfully treated with combination chemotherapy along with withdrawal of immunosuppression. The patient remains in complete remission more than 2 years after his diagnosis. We also provide a succinct review of treatment of various PTLD and discuss the role of Epstein-Barr virus infection in the pathogenesis of PTLD.

Ectopic hormone production is an uncommon complication of neoplastic lung disease. Rarely, patients may present with signs and symptoms of systemic endocrine dysfunction related to a hormone-secreting tumor. Bronchopulmonary carcinoids are the most common neoplasm implicated in ectopic ACTH-dependent Cushing's syndrome. Persistent hypercortisolism, such as that which occurs in Cushing's syndrome, causes immunosuppression and makes patients vulnerable to opportunistic infections. We present a case of a 42-year-old woman diagnosed with ACTH-dependent Cushing's syndrome which was originally thought to stem from a pituitary lesion as interpreted on magnetic resonance imaging. Her symptoms persisted after undergoing hypophysectomy, and further work-up involving a fine needle aspiration of the left lung revealed an ACTH-producing carcinoid tumor. Before treatment could be administered, the patient developed several new suspicious nodules in the left lung that were shown by fine needle aspiration to be infectious in nature. A Gram stain revealed numerous Gram positive branching organisms, and culture of the specimen grew Nocardia asteroides. Her pulmonary infection was treated with antibiotics and she underwent successful ablation of the carcinoid tumor.

BackgroundChronic Lymphocytic Leukemia (CLL) is a lymphoproliferative disease characterized by multiple recurring clonal cytogenetic anomalies and is the most common leukemia in adults. Chromosomal abnormalities associated with CLL include trisomy 12 and IGH;BCL3 rearrangement [t(14;19)(q32;q13)] that juxtaposes a proto-oncogenic gene BCL3 and an immunoglobulin heavy chain, a translocation that may be associated with shorter survival. In addition to the IGH;BCL3 rearrangement, other translocations involving 14q32 locus are involved in various lymphoproliferative pathologies pointing toward the significance of IGH locus in oncogenic progression. Significantly, in the majority of B-cell neoplasms that carry an IGH;BCL3 rearrangement, it is a sole translocation involving an IGH locus.Case PresentationWe report a patient who, in addition to trisomy 12, carried a rare double-hit translocation characterized by the IGH;BCL3 translocation and an additional clonal IGH;BCL2 translocation involving IGH and another proto-oncogene BCL2, t(14;18)(q32;q21), commonly found in follicular lymphoma. Further single nucleotide polymorphism (SNP) array-based analysis detected a duplication of the 58.8 kb region at 19q13.32 adjacent to the BCL3 translocation junction on chromosome 19q13. Interestingly, the duplicated region contained ERCC2 gene, which encodes a DNA excision repair protein involved in the cancer-prone syndrome, xeroderma pigmentosum.ConclusionsTaken together our findings indicate the existence of double-translocation driven oncogenic events involving both IGH loci and proto-oncogenes BCL2 and BCL3. Importantly, the IGH;BCL3 translocation was characterized by the duplication of the genomic region adjacent to BCL3, containing a major DNA repair factor, ERCC2.Electronic supplementary materialThe online version of this article (doi:10.1186/s13039-015-0203-y) contains supplementary material, which is available to authorized users.

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A 16-year-old girl with B-lineage acute lymphoblastic leukemia was hospitalized for management of fever and neutropenia. She was empirically treated with intravenous vancomycin and ceftazidime. Her fever persisted, and on the seventh day of hospitalization, she developed a painful generalized erythematous rash. There was no history of trauma, infectious contacts, travel, gardening or pet exposures.On physical examination, she was febrile (39.2°C), but appeared well with no apparent distress. A skin examination revealed a rash that consisted of numerous violaceous papules, nodules and plaques on her trunk, abdomen and lower extremities. The lesions were surrounded by a 1 cm area of cellulitis, and some had necrotic centres (Figure 1). Otolaryngological evaluation revealed a necrotic nasal septum. Her abdominal examination was significant for hepatosplenomegaly. The rest of the examination was unremarkable.Laboratory data were significant for a white blood cell count of 0.4×10 9 /L, hemoglobin level of 84 g/L and a platelet count of 21×10 9 /L. Renal function and liver enzymes were normal; blood and urine cultures were negative for bacteria and fungi. A computed tomography scan of the chest with contrast revealed bilateral pulmonary nodules. A cutaneous punch biopsy was performed, and specimens were submitted for culture and histopathology (Figures 2 and 3).What is the diagnosis?Skin nodules in a 16-year-old adolescent with acute lymphoblastic leukemia