World Health Organization PTLD Classification of 2001 |
Category |
Examples |
Histopathology |
Immunophenotype |
Clonal Status |
Oncogene, Tumor Suppressor Gene Changes |
Comments |
"Early" lesions |
Reactive plasmacytic hyperplasia (PH)
infectious mononucleosis-like PTLD |
Some architectural preservation; numerous plasma cells and lymphocytes;variable paracortical expansion; many immunoblasts may be present; atypia slight; some cases may have overlapping features of PH and IM-PTLD |
Polyclonal B cells, plasma cells and T cells. Immunoblasts often EBV-positive |
Polyclonal; EBV present in most case of PH-
IM cases typically EBV positive, may have minor monoclonal or oligoclonal bands |
(None) |
Often regress with reduced immunosuppression, severe cases may be fatal Examples of posttransplant plasmacytic hyperplasia without EBV should not be considered as PTLD. |
Polymorphic PTLD |
Polymorphic B cell hyperplasia, Polymorphic B cell lymphoma |
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 |
Mixture of B and T lymphocytes, surface and cytoplasmic Ig polytypic or monotypic; most cases EBV positive |
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 |
Monomorphic PTLD |
B-cell neoplasms: Diffuse large B-cell lymphoma, Burkitt's or Burkitt-like lymphoma, plasma cell myeloma, plasmacytoma-like lesions
T-cell neoplasms: Peripheral T-cell
lymphoma, not otherwise specified; other types |
Morphological lymphomas; classify according to current lymphoma categorization; most to all cells transformed, blastic (plasma cell leisons excepted); most look like diffuse large B-cell lymphoma, other types less common; Monomorphic T-cell PTLD probably inlcudes most or all types of T-cell neoplasms |
B cell PTLD show CD19, 20, 79a; monotypic Ig expressoin in 50%; Many express CD43, CD45RO (due to upregulation of these T cell markers in B cells harboring EBV); CD30 often postive; most EBV pos.
T cell PTLD may express CD4 or 8, CD56, CD30, and alpha-beta or gamma-delta T-cell receptors |
Monoclonal Ig genes in B cell PTLD; EBV pos. cases also have clonal EBV; T cell PTLD usu. have clonal T cell receptor; 25% with clonal EBV |
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; Regression possible but uncommon compared to early lesions and polymorphic PTLD. Overall mortality 60% solid organ, 80% marrow recipients. |
Hodgkin lymphoma and Hodgkin lymphoma-like PTLD |
Classic HL; Hodgkin-like PTLD |
Reed Sternberg cells in appropriate backgound (see comments) |
Classic HD CD15, CD30 pos; HD-like PTLD more atypical phenotype, usu B cell antigens expressed; all or almost all cases EBV pos (HD and HD-like) |
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Since Reed-Sternberg-like cells can be seen in polymorphic PTLD, diagnosis requires appropriate morphologic and immunophenotypic features |
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