PMC5797803_01
(A) Liver biopsy showing mild acute cellular rejection with focal portal and central vein endothelialitis and focal lymphocytic cholangitis. (B) Immunohistochemical stain for latent membrane protein-1 showing only a single positive cell. (C) Epstein-Barr virus (EBV)-encoded RNA in-situ hybridization showing scattered positive portal and rare lobular cells consistent with EBV infection.
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F1
Liver biopsy demonstrated moderate acute rejection with concomitant EBV infection of the allograft as shown by immunohistochemistry and in-situ hybridization (Figure 1).
(A) Non-contrast abdominal/pelvic computed tomography (CT). (B) Positron-emission tomography-CT showing a fluorodeoxyglucose-avid left adrenal lesion measuring up to 1.9 cm with a max standardized uptake value of 7.0 (Deauville X).
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F2
Positron-emission tomography-computed tomography (PET-CT) showed a new 1.9-cm fluorodeoxyglucose-avid lesion in the left adrenal gland that was concerning for metastatic HCC (Figure 2).
(A) Atypical lymphoid infiltration of adrenal parenchyma on hematoxylin and eosin staining is composed of a mixture of plasma cells, small lymphocytes, and scattered larger lymphoid cells, some resembling immunoblasts and others Reed-Sternberg cells. (B) Diffuse positive staining for EBV by EBV-encoded RNA in-situ hybridization.
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F3
Liver biopsy was normal (Figure 3).