International Journal of Hematology

DOI: 10.1007/s12185-018-2410-x Pages: 1-10

Classical Hodgkin lymphoma type post-transplant lymphoproliferative disorder in a kidney transplant recipient: a diagnostic pitfall

1. Takatsuki General Hospital, Department of Pathology

2. Kobe University Graduate School of Medicine, Department of Pathology

3. Takatsuki General Hospital, Department of Hematology

4. Kyoto University Hospital, Department of Hematology

5. Nagoya University Graduate School of Medicine, Department of Pathology and Laboratory Medicine

6. Aichi Cancer Center Hospital, Department of Pathology and Molecular Diagnostics

Correspondence to:
Yoshihiro Ikura
Email: ikura@ajk.takatsuki-hp.or.jp

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Abstract

We report a case of classical Hodgkin lymphoma type post-transplant lymphoproliferative disorder (HL-PTLD) after kidney transplantation to highlight the difficulty of distinguishing this disorder from Hodgkin lymphoma-like PTLD (HL-like PTLD). Through this case report and literature review, we seek to clarify definitive pathologic features to differentiate these two conditions. A 38-year-old male kidney transplant recipient who had been receiving immunosuppressants was admitted to our hospital with unidentified high fever. Computed tomography images and blood tests indicated a lymphoproliferative disorder. Abdominal lymph node biopsy was performed, and microscopic examination revealed the presence of many large atypical cells in a background of dense T cell accumulation. The large, atypical cells were positive for Epstein–Barr Virus (EBV)-encoded small RNAs (EBER) in situ hybridization, EBV-LMP1, CD30 and PAX5, but negative for CD15, CD20 and CD45. Except for CD15-negativity, this immunohistochemical pattern was consistent with that of classical Hodgkin lymphoma. By close examination of the above immunoreactivities and the patient’s subsequent chemosensitive clinical course, we finally made a diagnosis of HL-PTLD.

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