Classical Hodgkin Lymphoma type Post-transplant ...lasop.com/pgs/hdouts/2009-06_PTLD Classic HD...
Transcript of Classical Hodgkin Lymphoma type Post-transplant ...lasop.com/pgs/hdouts/2009-06_PTLD Classic HD...
History
Now 17 year old male Velocardiofacial syndrome with
hypoplastic left heart Heart transplant at 13 weeks of age Multiple medical problems
6 years prior: post-transplant lymphoproliferativedisorder
6 months prior: acute rejection
History
Worsening fatigue and irritability
Physical Exam - unremarkable
Laboratory studies: Pancytopenia Acute renal failure
Current Hospitalization
Increasing fatigue, irritability
3.5 cm mass in right lobe of liver
Developed sepsis
CD30CD15
EBER
EBER
POST-TRANSPLANT LYMPHOPROLIFERATIVE
DISORDER (PTLD),
CLASSICAL HODGKIN LYMPHOMA TYPE
Diagnosis
Post-transplant lymphoproliferative disorder (PTLD)
A lymphoid or plasmacytic proliferation which develops consequent to immunosuppressionin recipients of solid organ, bone marrow or
stem cell transplants
Post-transplant lymphoproliferative disorder
Pathogenesis Epstein-Barr virus (EBV):
Up to 100% - Early lesionsMinority of cases EBV negative
Other viruses ?Possible candidate KSHV/HHV 8
Post-transplant lymphoproliferative disorders
2001 WHO Classification1) Early lesions
Plasmacytic hyperplasia Infectious mononucleosis-
like
2) Polymorphic
3) Monomorphic B-cell neoplasms T-cell neoplasms
4) Hodgkin lymphoma and Hodgkin lymphoma-like
Post-transplant lymphoproliferative disorders
2001 WHO Classification1) Early lesions
Plasmacytic hyperplasia Infectious
mononucleosis-like
2) Polymorphic
3) Monomorphic B-cell neoplasms T-cell neoplasms
4) Hodgkin lymphoma and Hodgkin lymphoma-like
2008 WHO Classification1) Early lesions
Plasmacytic hyperplasia Infectious mononucleosis-
like
2) Polymorphic
3) Monomorphic B-cell neoplasms T-cell neoplasms
4) Classical Hodgkin lymphoma-type
Hodgkin lymphoma-like PTLD
(HL-like PTLD)
vs
Classical Hodgkin lymphoma
type PTLD (cHL PTLD)
Classical Hodgkin lymphoma type PTLD Hodgkin lymphoma-like PTLD
CD45 CD20
CD30 CD15
Classical Hodgkin lymphoma type PTLD
CD45 CD20
CD30 CD15
Hodgkin lymphoma-like PTLD
Classical Hodgkin lymphoma type PTLD Hodgkin lymphoma-like PTLD
EBER EBER
Molecular Findings
Hodgkin lymphoma-like PTLD:
Clonality demonstrated by B-cell gene
rearrangement studies
Classical Hodgkin lymphoma type PTLD:
Clonality limited to single HRS cells
Post-transplant lymphoproliferative disorders
2001 WHO Classification1) Early lesions
2) Polymorphic
3) Monomorphic B-cell neoplasms T-cell neoplasms
4) Hodgkin lymphoma and Hodgkin lymphoma-like
2008 WHO Classification1) Early lesions
2) Polymorphic
3) Monomorphic B-cell neoplasms T-cell neoplasms
4) Classical Hodgkin lymphoma-type
cHL-PTLD vs. HL-like PTLD
cHL-PTLD HL-like PTLD
Morphology HRS cells in HRS cells in
background of small background of small
lymphocytes lymphocytes
cHL-PTLD vs. HL-like PTLD
cHL-PTLD HL-like PTLD
Morphology HRS cells in HRS cells in
background of small background of small
lymphocytes lymphocytes
Immunophenotype CD45-, CD20-, CD45+, CD20+,
CD30+, CD15+ CD30+/-, CD15-
cHL-PTLD vs. HL-like PTLD
cHL-PTLD HL-like PTLD
Morphology HRS cells in HRS-like cells in background of small background of smalllymphocytes lymphocytes
Immunophenotype CD45-, CD20-, CD45+, CD20+, CD30+, CD15+ CD30+/-, CD15-
EBV status EBER+ in EBER+ variable HRS cells only in HRS cells and
small bystander lymphocytes
cHL-PTLD vs. HL-like PTLDcHL-PTLD HL-like PTLD
Morphology HRS cells in HRS-like cells in background of small background of smalllymphocytes lymphocytes
Immunophenotype CD45-, CD20-, CD45+, CD20+, CD30+, CD15+ CD30+/-, CD15-
EBV status EBER+ in EBER+ variable HRS cells only in HRS cells and
small bystander lymphocytes
Molecular Difficult to Clonalitydemonstrate in whole tissue DNAclonality
Clinical & Prognostic Implications
HL-like PTLD Behaves like a non-Hodgkins lymphoma Rx: reduction of immunosuppression,
rituximab, and NHL chemotherapy cHL-PTLD
Is a true Hodgkins lymphoma Rx: reduction of immunosuppression, Hodgkin
lymphoma chemotherapy Rituximab?
Conclusion HL-like PTLD and cHL-PTLD are
morphologically similar
However, there are significant immunophenotypic and molecular genetic differences between the two entities
Distinction between cHL and HL-like PTLD may be important for their clinical management
Pitman SD, et al. Am J Surg Path.2006;30:470-476 and 2008 WHO book pp343-349
Acknowledgements
Dr. Jun Wang Dr. Craig Zuppan Dr. Jeffery Cao Dr. Katie Wilkinson
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