Early Development of Epstein-Barr Virus-Associated T-Cell Lymphoma After a Living-Related Renal Transplantation

Abstract

We herein report a case of Epstein-Barr virus (EBV)-associated T-cell lymphoma that developed within a month after a kidney transplantation. The recipient was a 37-year-old man who had evidence of a previous EBV infection. Cyclosporine, methylprednisolone, and azathioprine were used for immunosuppression, and acute rejection was treated with high-dose methylprednisolone. The lactate dehydrogenase level started to increase on day 24 and thereafter peaked on day 37 while also demonstrating progressive jaundice and a bleeding tendency. A transplant nephrectomy was done on day 37; however, the patient could not recover and eventually died of respiratory failure as a result of diffuse pulmonary edema. A pathological examination of the resected kidney revealed a diffuse proliferation of large atypical lymphoid cells in the parenchyma. Immunohistochemically, the tumor cells were positive for CD45 and T-cell marker, CD45RO, but negative for B-cell markers. EBV-encoded RNA was demonstrated within the neoplastic cells by in situ hybridization.

Primary ???Cutaneous??? T-Cell Anaplastic Large Cell Lymphoma, CD30+, Neutrophil-Rich Variant with Subcutaneous Panniculitic Lesions, in a Post-Renal Transplant Patient

“…It also suggests that EBV does not play a role in their pathogenesis, in contrast to T-cell lymphomas following transplantation and involving other organs, in which EBV was detected in 10 of the 23 cases tested. [44][45][46] Although the pathogenetic mechanisms involved in the development of these rare ''cutaneous'' T-cell lymphomas in the secondary iatrogenic immunodeficiency remains unsettled, factors other than EBV seem to lead to the oncogenic transformation in these patients. 47 …”

Post-transplant cutaneous T-cell lymphomas

“…Studies in the general population do not support a role for HTLV-1 in the pathogenesis of the vast majority of CTCL [36]. EBV has been incriminated in the development of some T-cell lymphomas [27,20]. However, the known lymphotropic viruses do not appear to be frequently involved in post-transplant T-cell lymphomas [30].…”

“…A similar feature of post-transplant T-cell proliferation and posttransplant B-cell proliferation is the predominant extranodal presentation [13]. Although EBV has been less frequently associated with post-transplant T-cell lymphoproliferative disorders, an aetiological role in the setting of immunosuppression has also been hypothesized [13,16,[18][19][20]. Antibodies to human T-cell leukaemia virus-1 (HTLV1) and human immunodeficiency viruses 1 and 2 (HIV1, HIV2) are not detected in the blood [21,22].…”

Detection of Epstein-Barr Virus in Posttransplantation T Cell Lymphoma in a Kidney Transplant Recipient: Case Report and Review

“…At our hospital, only 3 cases of PTLDs have been diagnosed for 250 kidney transplant recipients: the case of T cell lymphoma reported here, a case of B cell lymphoma, and a case of multiple myeloma. After reviewing the literature via MEDLINE, we found only 8 other cases of PTTL in which EBV was demonstrated by 1 or 2 specific methods [1,4,[6][7][8][9]. The clinicopathologic features of the 8 previously described patients are shown in table 1.…”

“…Treatment of PTTLs (such as decrease or discontinuation of immunosuppressive therapy, chemotherapy, and treatment with acyclovir, ganciclovir, IFN-a, and antibodies to CD21 and CD24) has been used alone or in combination with different outcomes [1][2][3][4][6][7][8][9]. Our patient was treated with surgical removal of the tumor, decrease in immunosuppressive therapy (discontinuation of azathioprine treatment), and chemotherapy with a good result.…”