Which histologic findings are characteristic of lung transplantation-related PTLD?

Updated: Jun 06, 2019
  • Author: Aliya N Husain, MBBS, MD; Chief Editor: Philip T Cagle, MD  more...
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Answer

Answer

PTLD is an EBV-driven condition that has been described in all transplant populations and is a particular problem in lung allograft recipients, in whom it usually involves the allograft itself, as well as nodal and extranodal sites. Improved immunosuppression modalities have decreased the overall incidence of PTLD; however, the incidence is reported to vary between 1% and 11.7%. [7, 8]

Histologically, PTLD may range from a collection of cytologically benign polyclonal lymphocytes to a monoclonal proliferation with features akin to a high-grade B-cell lymphoma (see the image below). PTLD confined to the allograft has a better overall outcome than disseminated disease. [9]

Lung transplantation-related pathology. This image Lung transplantation-related pathology. This image demonstrates posttransplant lymphoproliferative disorder (PTLD): There is a diffuse infiltrate of atypical lymphoid cells, obliterating the lung architecture, with a foci of necrosis, as would be seen in a large-cell lymphoma (hematoxylin and eosin [H&E], 200x).

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