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Kajimoto Y, Terasaki Y, Terasaki M, Kunugi S, Okabe Y, Wakita S, Inokuchi K, Shimizu A. T-cell lymphoma with a granulomatous lesion of the lungs after autologous hematopoietic stem cell transplantation for Epstein-Barr virus-positive diffuse large B-cell lymphoma: a unique rare case of metachronous B-cell and T-cell lymphoma. Diagn Pathol 2020; 15:125. [PMID: 33036636 PMCID: PMC7547518 DOI: 10.1186/s13000-020-01038-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 09/20/2020] [Indexed: 11/25/2022] Open
Abstract
Background Epstein–Barr virus (EBV) is associated with the pathogenesis of a variety of malignancies, most notably lymphomas. Especially in the background of immunodeficiency, such as primary immunodeficiency disorder (PID) and post-transplant lymphoproliferative disorder (PTLD), the role of EBV might be crucial. PIDs are rare heterogeneous diseases affecting the development and/or the function of the innate and adaptive immune system. Malignancy is the second-highest cause of death after infection, and lymphoma accounts for about half of malignancies. The most frequently reported lymphoma type is diffuse large B-cell lymphoma (DLBCL) and the incidence of T-cell lymphoma is rare. PTLDs are also rare serious lymphoid and/or plasmacytic proliferative disorders that occur after undergoing solid organ or hematopoietic stem cell transplantation (HSCT). In the context of HSCT, most reported PTLDs have occurred in patients who received allogenic HSCT, but only a few cases have been reported in autologous HSCT (AutoHSCT) recipients. Case presentation A 53-year-old female patient initially presented with enlargement of the left cervical lymph nodes and was diagnosed with EBV-positive DLBCL. She was treated with R-CHOP, R-ACES, and AutoHSCT and went into remission. Four years later, computed tomography results revealed multiple lung nodules and abnormal infiltration, and sustained and progressing hypogammaglobulinemia was observed. The pathological specimen of video-assisted thoracoscopic surgical lung biopsy demonstrated extensive invasion of lymphocytes with notable granuloma findings. Flow cytometric immunophenotyping analysis showed that lymphocytes were positive for CD3 and CD5; especially, CD3 was expressed in the cytoplasm. Southern blot analysis revealed rearrangements of the T-cell receptor Cβ1 gene. She was diagnosed with peripheral T-cell lymphoma, not otherwise specified, accompanied by notable granulomatous lesions. Conclusion Here, as a unique case of metachronous B-cell and T-cell lymphoma, we report a rare case of T-cell lymphoma that mainly affected the lungs with the presentation of notable granulomatous findings following AutoHSCT for EBV-positive DLBCL at the age of 53 years. These lung lesions of granulomatous T-cell lymphoma could be related to the underlying primary immunodeficiency background associated with sustained hypogammaglobulinemia.
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Affiliation(s)
- Yusuke Kajimoto
- Department of Analytic Human Pathology, Nippon Medical School, 1-25-16, Nezu, Bunkyo-ku, Tokyo, 113-0031, Japan
| | - Yasuhiro Terasaki
- Department of Analytic Human Pathology, Nippon Medical School, 1-25-16, Nezu, Bunkyo-ku, Tokyo, 113-0031, Japan. .,Division of Pathology, Nippon Medical School Hospital, 1-1-5, Sendagi, Bunkyo-ku, Tokyo, 113-8602, Japan.
| | - Mika Terasaki
- Department of Analytic Human Pathology, Nippon Medical School, 1-25-16, Nezu, Bunkyo-ku, Tokyo, 113-0031, Japan
| | - Shinobu Kunugi
- Department of Analytic Human Pathology, Nippon Medical School, 1-25-16, Nezu, Bunkyo-ku, Tokyo, 113-0031, Japan
| | - Yugo Okabe
- Department of Analytic Human Pathology, Nippon Medical School, 1-25-16, Nezu, Bunkyo-ku, Tokyo, 113-0031, Japan
| | - Satoshi Wakita
- Department of Hematology, Nippon Medical School Hospital, 1-1-5, Sendagi, Bunkyo-ku, Tokyo, 113-8602, Japan
| | - Koiti Inokuchi
- Department of Hematology, Nippon Medical School Hospital, 1-1-5, Sendagi, Bunkyo-ku, Tokyo, 113-8602, Japan
| | - Akira Shimizu
- Department of Analytic Human Pathology, Nippon Medical School, 1-25-16, Nezu, Bunkyo-ku, Tokyo, 113-0031, Japan
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Cancer Therapy-associated Lymphoproliferative Disorders: An Under-recognized Type of Immunodeficiency-associated Lymphoproliferative Disorder. Am J Surg Pathol 2017; 42:116-129. [PMID: 29112013 DOI: 10.1097/pas.0000000000000954] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
We describe the clinicopathologic features of 17 patients who had a hematologic malignancy of various types, were treated, and subsequently developed a lymphoproliferative disorder (LPD). There were 10 men and 7 women with a median age of 59 years (range, 36 to 83 y). The primary hematologic neoplasms included: 5 chronic lymphocytic leukemia/small lymphocytic lymphoma, 3 plasma cell myeloma, 2 acute monoblastic leukemia, and 1 case each of mixed-phenotype acute leukemia, chronic myeloid leukemia, splenic marginal zone lymphoma, follicular lymphoma, mantle cell lymphoma, T-cell prolymphocytic leukemia, and peripheral T-cell lymphoma. All patients were treated with chemotherapy with or without therapeutic antibodies; 3 also underwent autologous stem cell transplantation. The mean interval from initiation of therapy for initial hematologic malignancy to onset of LPD was 66 months (range, 3 to 299 mo). Ten (59%) LPDs were extranodal and 7 (41%) involved nodal tissues. The histologic diagnoses included: 8 diffuse large B-cell lymphoma, 4 classical Hodgkin lymphoma, 3 polymorphic LPD, 1 lymphomatoid granulomatosis, and 1 Epstein-Barr virus (EBV) mucocutaneous ulcer. Fourteen cases were EBV. Following the onset of LPD, chemotherapy was administered to 10 (59%) patients. With a median follow-up of 100 months (range, 5 to 328 mo), 8 (47%) patients are alive and 9 (53%) died. One (6%) patient with lymphomatoid granulomatosis underwent spontaneous remission. On the basis of the clinicopathologic features and high prevalence of EBV infection in this cohort, we believe that these LPDs show similarities with other types of immunodeficiency-associated LPDs. We suggest that cancer therapy-associated LPD be included in future classification systems for immunodeficiency-associated LPDs.
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Satou A, Kohno A, Fukuyama R, Elsayed AA, Nakamura S. Epstein-Barr virus-positive mucocutaneous ulcer arising in a post-hematopoietic cell transplant patient followed by polymorphic posttransplant lymphoproliferative disorder and cytomegalovirus colitis. Hum Pathol 2016; 59:147-151. [PMID: 27569297 DOI: 10.1016/j.humpath.2016.08.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Revised: 08/01/2016] [Accepted: 08/11/2016] [Indexed: 11/18/2022]
Abstract
Epstein-Barr virus (EBV)-positive mucocutaneous ulcer (EBVMCU) is a newly described entity occurring in elderly or iatrogenically immunocompromised patients. We describe a case of EBVMCU arising in a post-hematopoietic cell transplant patient and followed by EBV-positive polymorphic posttransplant lymphoproliferative disorder (EBV+ polymorphic PTLD). The patient, a 52-year-old woman, received chemotherapy and autologous peripheral blood stem cell transplantation for relapsed diffuse large B-cell lymphoma (DLBCL). She achieved complete remission and was followed up in an outpatient clinic after discharge. One year later, EBVMCU appeared in the tongue and exhibited spontaneous regression. Six months after the regression of the EBVMCU, she had EBV+ polymorphic PTLD, analogous to EBV+ polymorphic DLBCL. The therapy for PTLD was not effective, and the patient finally died of disease progression. This was the first case of EBVMCU characterized by both an association with autologous peripheral blood stem cell transplantation and subsequent emergence of malignant lymphoma in a patient with relapsed DLBCL.
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MESH Headings
- Biopsy
- Colitis, Ulcerative/diagnosis
- Colitis, Ulcerative/immunology
- Colitis, Ulcerative/virology
- Cytomegalovirus Infections/diagnosis
- Cytomegalovirus Infections/immunology
- Cytomegalovirus Infections/virology
- Disease Progression
- Epstein-Barr Virus Infections/diagnosis
- Epstein-Barr Virus Infections/drug therapy
- Epstein-Barr Virus Infections/immunology
- Epstein-Barr Virus Infections/virology
- Fatal Outcome
- Female
- Hematopoietic Stem Cell Transplantation/adverse effects
- Herpesvirus 4, Human/genetics
- Herpesvirus 4, Human/isolation & purification
- Humans
- Immunocompromised Host
- Immunohistochemistry
- Immunosuppressive Agents/adverse effects
- In Situ Hybridization
- Lymphoma, Large B-Cell, Diffuse/diagnosis
- Lymphoma, Large B-Cell, Diffuse/surgery
- Lymphoproliferative Disorders/diagnosis
- Lymphoproliferative Disorders/drug therapy
- Lymphoproliferative Disorders/immunology
- Lymphoproliferative Disorders/virology
- Middle Aged
- Opportunistic Infections/diagnosis
- Opportunistic Infections/immunology
- Opportunistic Infections/virology
- Polymerase Chain Reaction
- RNA, Viral/genetics
- Recurrence
- Time Factors
- Tongue Diseases/diagnosis
- Tongue Diseases/immunology
- Tongue Diseases/virology
- Ulcer/diagnosis
- Ulcer/immunology
- Ulcer/virology
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Affiliation(s)
- Akira Satou
- Department of Pathology and Laboratory Medicine, Nagoya University Hospital, Nagoya, Japan; Department of Surgical Pathology, Aichi Medical University Hospital, Nagakute, Japan; Department of Diagnostic Pathology, Konan Kosei Hospital, Konan, Japan.
| | - Akio Kohno
- Department of Hematology and Oncology, Konan Kosei Hospital, Konan, Japan
| | - Ryuichi Fukuyama
- Department of Diagnostic Pathology, Konan Kosei Hospital, Konan, Japan
| | - Ahmed Ali Elsayed
- Department of Pathology and Laboratory Medicine, Nagoya University Hospital, Nagoya, Japan; Department of Pathology, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Shigeo Nakamura
- Department of Pathology and Laboratory Medicine, Nagoya University Hospital, Nagoya, Japan
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Inazawa N, Hori T, Nojima M, Saito M, Igarashi K, Yamamoto M, Shimizu N, Yoto Y, Tsutsumi H. Virus reactivations after autologous hematopoietic stem cell transplantation detected by multiplex PCR assay. J Med Virol 2016; 89:358-362. [PMID: 27364410 DOI: 10.1002/jmv.24621] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/26/2016] [Indexed: 11/05/2022]
Abstract
Several studies have indicated that viral reactivations following allogeneic hematopoietic stem cell transplantation (allo-HSCT) are frequent, but viral reactivations after autologous HSCT (auto-HSCT) have not been investigated in detail. We performed multiplex polymerase chain reaction (PCR) assay to examine multiple viral reactivations simultaneously in 24 patients undergoing auto-HSCT between September 2010 and December 2012. Weekly whole blood samples were collected from pre- to 42 days post-HSCT, and tested for the following 13 viruses; herpes simplex virus 1 (HSV-1), HSV-2, varicella-zoster virus (VZV), Epstein-Barr virus (EBV), cytomegalovirus (CMV), human herpesvirus 6 (HHV-6), HHV-7, HHV-8, adeno virus (ADV), BK virus (BKV), JC virus (JCV), parvovirus B19 (B19V), and hepatitis B virus (HBV). Fifteen (63%) patients had at least one type of viral reactivation. HHV6 (n = 10; 41.7%) was most frequently detected followed by EBV (n = 7; 29.2%). HHV-6 peaked on day 21 after HSCT and promptly declined. In addition, HBV, CMV, HHV7, and B19V were each detected in one patient. HHV6 reactivation was detected in almost half the auto-HSCT patients, which was similar to the incidence in allo-HSCT patients. The incidence of EBV was unexpectedly high. Viral infections in patients undergoing auto-HSCT were higher than previously reported in other studies. Although there were no particular complications of viral infection, we should pay attention to possible viral reactivations in auto-HSCT patients. J. Med. Virol. 89:358-362, 2017. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Natsuko Inazawa
- Department of Pediatrics, JCHO Sapporo Hokushin Hospital, Sapporo, Japan
| | - Tsukasa Hori
- Department of Pediatrics, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Masanori Nojima
- The Institute of Medical Science Hospital, Tokyo University, Tokyo, Japan
| | - Makoto Saito
- Department of Pediatrics, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Keita Igarashi
- Department of Pediatrics, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Masaki Yamamoto
- Department of Pediatrics, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Norio Shimizu
- Department of Virology Medical Research Institute, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yuko Yoto
- Department of Pediatrics, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Hiroyuki Tsutsumi
- Department of Pediatrics, Sapporo Medical University School of Medicine, Sapporo, Japan
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Luskin MR, Roy DB, Wasik MA, Loren AW. Development of lymphomas containing Epstein-Barr virus after therapy with hyper-CVAD regimen. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2013; 14:e55-8. [PMID: 24393621 DOI: 10.1016/j.clml.2013.11.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/03/2013] [Revised: 11/05/2013] [Accepted: 11/17/2013] [Indexed: 01/27/2023]
Affiliation(s)
- Marlise R Luskin
- Abramson Cancer Center, Division of Hematology and Oncology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA.
| | - Darshan B Roy
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Mariusz A Wasik
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Alison W Loren
- Abramson Cancer Center, Division of Hematology and Oncology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
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Ishida M, Hodohara K, Yoshii M, Okuno H, Horinouchi A, Nakanishi R, Harada A, Iwai M, Yoshida K, Kagotani A, Yoshida T, Okabe H. Methotrexate-related Epstein-Barr virus-associated lymphoproliferative disorder occurring in the gingiva of a patient with rheumatoid arthritis. INTERNATIONAL JOURNAL OF CLINICAL AND EXPERIMENTAL PATHOLOGY 2013; 6:2237-2241. [PMID: 24133604 PMCID: PMC3796248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 08/12/2013] [Accepted: 08/28/2013] [Indexed: 06/02/2023]
Abstract
It is well recognized that patients with immunodeficiency have a high risk of development of lymphoproliferative disorders (LPDs), and Epstein-Barr virus (EBV) is associated with the occurrence of LPDs. Methotrexate (MTX) is one of the common cause of iatrogenic-associated LPD, and approximately 40-50% of MTX-related LPD cases occur in extranodal sites. However, the occurrence of MTX-related LPD in the gingiva is extremely rare. Herein, we report the fourth documented case of MTX-related EBV-associated LPD occurring in the gingiva of a patient with rheumatoid arthritis (RA). A 76-year-old Japanese female with a 10-year history of RA, who was treated with MTX and infliximab, presented with a tumorous lesion in the gingiva. Biopsy of the gingiva tumor revealed diffuse proliferation of large-sized lymphoid cells with cleaved nuclei containing conspicuous nucleoli. These lymphoid cells were CD20- and EBER-positive. Therefore, a diagnosis of MTX-related EBV-associated LPD showing features of diffuse large B-cell lymphoma (DLBCL) that occurred in the gingiva was made. Although the occurrence of LPD in the oral region, as seen in the present case, is rare, the prevalence of this disorder may be on the rise due to the increased number of patients undergoing immunosuppression therapy. Moreover, immunosenescence can also be a cause of EBV-associated LPD. Therefore, recognition of the occurrence of this disorder in the oral cavity and consideration of the clinical history can facilitate the correct diagnosis.
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Affiliation(s)
- Mitsuaki Ishida
- Department of Clinical Laboratory Medicine, Shiga University of Medical ScienceShiga, Japan
- Division of Diagnostic Pathology, Shiga University of Medical ScienceShiga, Japan
| | - Keiko Hodohara
- Department of Hematology, Shiga University of Medical ScienceShiga, Japan
| | - Miyuki Yoshii
- Department of Clinical Laboratory Medicine, Shiga University of Medical ScienceShiga, Japan
| | - Hiroko Okuno
- Department of Clinical Laboratory Medicine, Shiga University of Medical ScienceShiga, Japan
| | - Akiko Horinouchi
- Department of Clinical Laboratory Medicine, Shiga University of Medical ScienceShiga, Japan
| | - Ryota Nakanishi
- Department of Clinical Laboratory Medicine, Shiga University of Medical ScienceShiga, Japan
| | - Ayumi Harada
- Department of Clinical Laboratory Medicine, Shiga University of Medical ScienceShiga, Japan
| | - Muneo Iwai
- Division of Diagnostic Pathology, Shiga University of Medical ScienceShiga, Japan
| | - Keiko Yoshida
- Division of Diagnostic Pathology, Shiga University of Medical ScienceShiga, Japan
| | - Akiko Kagotani
- Division of Diagnostic Pathology, Shiga University of Medical ScienceShiga, Japan
| | - Takashi Yoshida
- Department of Clinical Laboratory Medicine, Shiga University of Medical ScienceShiga, Japan
| | - Hidetoshi Okabe
- Department of Clinical Laboratory Medicine, Shiga University of Medical ScienceShiga, Japan
- Division of Diagnostic Pathology, Shiga University of Medical ScienceShiga, Japan
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Kim HO, Oh HJ, Lee JW, Jang PS, Chung NG, Cho B, Kim HK. Immune reconstitution after allogeneic hematopoietic stem cell transplantation in children: a single institution study of 59 patients. KOREAN JOURNAL OF PEDIATRICS 2013; 56:26-31. [PMID: 23390442 PMCID: PMC3564027 DOI: 10.3345/kjp.2013.56.1.26] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/14/2012] [Revised: 10/02/2012] [Accepted: 10/08/2012] [Indexed: 11/27/2022]
Abstract
Purpose Lymphocyte subset recovery is an important factor that determines the success of hematopoietic stem cell transplantation (HSCT). Temporal differences in the recovery of lymphocyte subsets and the factors influencing this recovery are important variables that affect a patient's post-transplant immune reconstitution, and therefore require investigation. Methods The time taken to achieve lymphocyte subset recovery and the factors influencing this recovery were investigated in 59 children who had undergone HSCT at the Department of Pediatrics, The Catholic University of Korea Seoul St. Mary's Hospital, and who had an uneventful follow-up period of at least 1 year. Analyses were carried out at 3 and 12 months post-transplant. An additional study was performed 1 month post-transplant to evaluate natural killer (NK) cell recovery. The impact of pre- and post-transplant variables, including diagnosis of Epstein-Barr virus (EBV) DNAemia posttransplant, on lymphocyte recovery was evaluated. Results The lymphocyte subsets recovered in the following order: NK cells, cytotoxic T cells, B cells, and helper T cells. At 1 month post-transplant, acute graft-versus-host disease was found to contribute significantly to the delay of CD16+/56+ cell recovery. Younger patients showed delayed recovery of both CD3+/CD8+ and CD19+ cells. EBV DNAemia had a deleterious impact on the recovery of both CD3+ and CD3+/CD4+ lymphocytes at 1 year post-transplant. Conclusion In our pediatric allogeneic HSCT cohort, helper T cells were the last subset to recover. Younger age and EBV DNAemia had a negative impact on the post-transplant recovery of T cells and B cells.
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Affiliation(s)
- Hyun O Kim
- Department of Pediatrics, The Catholic University of Korea College of Medicine, Seoul, Korea
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