Amniotic Sac Infection Syndrome Features Fetal Lung Neuroendocrine Cell Hyperfunction

Abstract

Epstein-Barr virus (EBV)-mediated lymphoid proliferations occur in patients who are immunocompromised and are reported following bone marrow or solid organ transplantation. Most post-transplant lymphoproliferative disorders (PTLD) are polymorphic in appearance; some are monomorphic and can resemble conventional malignant lymphomas. PTLD that resembles Hodgkin lymphoma has been reported infrequently. We herein report seven cases of PTLD that have large numbers of Reed-Sternberg-like (RS-like) cells and highlight differences in the phenotype of these cases that may distinguish Hodgkin-like PTLD (HL-PTLD) from true Hodgkin lymphoma/disease (HD). All patients were in the second decade of life and were 8 months to 13 years following transplant. HL-PTLD involves lymph nodes that contain a mixed population of small to intermediate-sized lymphocytes with large mononuclear and occasionally binucleate RS-like cells. The large cells of HL-PTLD are pleomorphic B cells that react strongly for CD20 and/or CD79a, express CD30, but are usually negative for CD15 and have few mitoses. They are positive for EBV early RNA (EBER) using an EBER-1 probe, as are some of the background small lymphocytes. A single case of true Hodgkin lymphoma has highly atypical RS-like cells that contain numerous mitoses, does not have CD20 or CD79a reactivity, has CD15 and CD30 staining, and the EBER-1 probe is confined to the large cells only. All patients were managed by withdrawal of immunosuppression and variably treated with either antiviral or anti-CD20 monoclonal antibody, or with chemotherapy. A unique instance of evolution from a HL-PTLD to true HD is also illustrated. In conclusion, HL-PTLD and HD appear to be two related but immunophenotypically and biologically distinct forms of lymphoproliferation in post-transplant patients and may require different protocols for their management.

Hodgkin lymphoma post‐transplant lymphoproliferative disorder: A comparative analysis of clinical characteristics, prognosis, and survival

“…Data on the treatment of HL-PTLD is even more scant and has been primarily restricted to case reports and case series totaling 39 patients [10–21,38]. Chemotherapy has been commonly administered, although follow-up varied greatly across reports.…”

“…Disease outcomes and prognostication for patients who develop HL-PTLD are not well described. Most available data on the treatment of HL-PTLD have been reported in case reports and small series [9–22], and thus, there is minimal guidance when evaluating and treating this unique patient population. One registry study identified 60 patients with HL-PTLD in renal transplant recipients, all of whom were diagnosed prior to 2001 [6].…”

Lymphoid Neoplasms After Allogeneic Hematopoietic Stem Cells Transplantation. The Case of Secondary Hodgkin’s Lymphoma, Differential Diagnosis With Post-Transplant Lymphoproliferative Disease

“…Случаи ПТЛПЗ, подобного лимфоме Ходжкина, встречаются очень редко, хотя и описаны [26][27][28]. Встречаемость данного состояния составляет 1,8-3,4 % от ПТЛПЗ у детей [29]. Наличие вариаций гистологической картины и клинических проявлений до сих пор вызывает дебаты, является ли эта патология формой лимфомы Ходжкина либо В-клеточным ПТЛПЗ.…”

Placental infectious villitis versus villitis of unknown etiology

“…The recurrence rate of placental inflammation, either acute or chronic, is higher than that of hypoxic and thrombotic placental lesions [1]. The amniotic sac infection syndrome associated with acute chorioamnionitis and caused by the acute bacterial ascending infection is the most common single cause of perinatal mortality, particularly in the 2 nd trimester [2]. The role of chronic villitis in perinatal morbidity and mortality cannot be overemphasized.…”