PTLD Class 1997
Posttransplant Neoplasia

PTLD Classification of 1997 (Harris et al.)
Category Examples Histopathology Clonal Status Oncogene, Tumor Suppressor Gene Changes Comments
"Early" lesions Reactive plasmacytic hyperplasia,  (atypical lymphoid hyperplasia)*, infectious mononucleosis-like Some architectural preservation; numerous plasma cells and lymphocytes; many immunoblasts may be present; atypia slight Polyclonal; Minor clones may be present (None) Often regress with reduced immunosuppression, severe cases may be fatal
PTLD-Polymorphic (Polymorphic B cell hyperplasia)*, (Polymorphic B cell lymphoma)*, (Polymorphic PTLD)* Destruction of underlying architecture, full range of B-cell maturation seen, may have necrosis, scattered large bizarre cells (atypical immunoblasts), frequent mitoses, may have monomorphic areas Monoclonal; Rare cases may be polyclonal None Overall impression of mixed small and large cell lymphoma or polymorphous immunocytoma; may be multiple; Some cases regress with reduced immunosuppression, others may progress
PTLD- Monomorphic B-cell lymphomas: Diffuse large B-cell lymphoma (e.g., immunoblastic, centroblastic, anaplastic subtypes), Burkitt's or Burkitt-like lymphoma
T-cell lymphomas:
Peripheral T-cell lymphoma, unspecificed type (usu. large cell), Anaplastic large cell lymphoma (T or null cell), Other types (eg, T-NK)
Majority of cells are transformed with cytologic atypia, prominent nucleoli, basophilic cytoplasm, underlying architectural effacement/destruction Monoclonal Present in some cases Recommended that these be classified according to standard lymphoma classification, with term " PTLD" added; Monomorphism means that most cells are transformed- cellular monotony may be present but is not required; T cell antigens CD43 and CD45RO may be present on B cells in these cases; Some B cell tumors may regress with reduced immunosuppression; T cell PTLD had longer time to onset and did not regress in this sample.
PTLD-Other a) T-cell rich/Hodgkin's disease-like B-PTLD, b) Plasmacytoma-like PTLD a) Diffuse background of small lymphocytes with scattered Reed-Sternberg-like cells; b) diffuse infiltrate of mature plasma cells Monoclonal None described T cell-rich/HD-like B-PTLD may regress with reduced immunosuppression

*Cases included in classification but examples not presented for review at Society for Hematopathology Workshop

  • Harris NL, Ferry JA, Swerdlow SH: Posttransplant lymphoproliferative disorders: Summary of Society for Hematopathology Workshop. Semin Diagn Pathol 14:8-14, 1997

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