This middle aged patient underwent a lung transplant 23 years prior and presented with abdominal pain and dark stools. Evaluation showed a large mesenteric lymph node mass, thickening of the distal ileum and liver lesions. The sample comes from the resected small bowel.This tumor is unusual for the long time interval between transplant and development of an EBV-positive tumor. The H&E shows a heterogeneous appearing diffusely distributed population of mononuclear tumor cells. Despite this "polymorphism", all of the cells appear neoplastic and the lesion fulfills criteria for non-Hodgkin lymphoma. In the current classification, this would place it within the general monomorphic category, which encompasses a variety of B, T and NK lymphomas. The term polymorphic is reserved for those infrequent PTLDs that have a heterogeneous but benign-appearing "activated" mononuclear background. Regarding lymphoma subtype, the B cell background and strong CD20 staining of enlarged neoplastic cells would exclude classic Hodgkin lymphoma. (image 1: H&E, image 2: CD20, image 3: CD3, image 4: EBER).
The present WHO classification of PTLDs (2017)
is available here.
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