PMC5548682_01
Computed tomography (CT) images showing an anterior mediastinal mass at the diagnosis of polymorphic post-transplant lymphoproliferative disorder (PTLD).
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Computed tomography (CT) revealed an anterior mediastinal mass (Fig. 1).
The pathological diagnosis of polymorphic PTLD. A needle biopsy showed mixed cell infiltration (A: Hematoxylin and Eosin staining, x600), including immunoblasts expressing CD20 (B: x600) and PAX5 (C: x600), CD3-positive lymphocytes (D: x600), and no CD30-positive cells (E: x600) or Epstein-Barr virus (EBV)-encoded small RNA (EBER)-positive cells (F: x600).
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A needle biopsy confirmed the diagnosis of polymorphic PTLD, which showed diffuse effacement of the nodal architecture with mixed cell proliferation including immunoblasts expressing CD20 and PAX5, plasma cells, a small number of CD20-negative Reed-Stenberg (RS)-like cells, and CD3-positive lymphocytes; however, these cells were negative for CD30 and Epstein-Barr virus (EBV) (Fig. 2).
The pathological diagnosis of classical Hodgkin lymphoma-type PTLD (CHL-type PTLD). A supraclavicular lymph node biopsy revealed a polymorphous lymphoid infiltrate with a large number of Reed-Sternberg (RS) cells (A: Hematoxylin and Eosin staining, x600), which showed specific positivity for CD30 (B: x600) and negativity for CD20 (C: x600);in situ hybridization revealed positivity for EBER (D: x600) and EBV latent membrane protein 1 (LMP1) (E: x600), and negativity for EBV nuclear antigen 2 (EBNA2) (F: x600). An XY-fluorescencein situ hybridization analysis showed that RS cells had one (A: white arrow) or two (B: red arrow) red chromosome X signals, while small-sized lymphocytes had one red chromosome X signal and one green chromosome Y signal (A: green arrow) (G and H).
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Immunohistochemical staining revealed that the RS cells were positive for CD15, CD30, PAX5, Epstein-Barr encoding region (EBER), and EBV latent membrane protein 1 (LMP1) and negative for CD3, CD20, and EBV nuclear antigen 2 (EBNA2) (Fig. 3A-F), which indicated type 2 latency according to the EBV antigen expression pattern in infected memory B cells. X signals), while small-sized lymphocytes in the background had chromosome X and Y signals (e.g. XY-type) (Fig. 3G and H).
A CT scan showing left-hilar lymphadenopathies and splenomegaly (spleen length 9.9 cm) at the diagnosis of CHL-type PTLD (A). A CT scan demonstrating the resolution of left-hilar lymphadenopathies and splenomegaly (spleen length 9.0 cm) before high-dose chemotherapy (B) and further resolution of stenosis of the trachea due to left-hilar lymphadenopathies and splenomegaly (spleen length 7.5 cm) after high-dose chemotherapy with stem cell rescue (C).
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SPD on CT (Fig. 4). Severe complications such as infection and organ failure did not occur after high-dose chemotherapy.