Contributed by Parmjeet S. Randhawa, M.D.
PATIENT HISTORY: Per referral report, the patient is a middle aged male with a history of lymphoma, chemotherapy, radiotherapy and renal transplant. R/O lymphoma. Pleural effusion and empyema mentioned in surgical pathologic report. Review of outside material.

Final Diagnosis (Case 1)

PART 1: RIGHT LOWER LOBE, WEDGE BIOPSY -
  1. NECROTIZING POLYMORPHOUS POST-TRANSPLANT LYMPHOPROLIFERATIVE DISEASE; EBER IN-SITU HYBRIDIZATION FOR EPSTEIN BARR VIRUS IS POSITIVE.

PART 2: MEDIASTINAL LYMPH NODE, LEVEL 9, EXCISIONAL BIOPSY -

  1. RECURRENT POLYMORPHOUS POST-TRANSPLANT LYMPHOPROLIFERATIVE DISEASE; IN-SITU HYBRIDIZATION FOR EPSTEIN BARR VIRUS IS POSITIVE.

Previous Biopsies on this Patient:
NONE

TPIS Related Resources:
Kidney Transplant Topics
Neoplasia Transplant Topics

Gross Description - Case 1

The specimen consists of eight (8) consult slides: Part 1 (1 HE, 3 unstained slides) and Part 2 (1 HE, 3 unstained) with accompanying surgical pathology reports. EBER in-situ hybridization was performed in our laboratory on both biopsy specimens.

Microscopic Description - Case 1

Sections from the lung show the parenchyma partly replaced by a lymphomatous infiltrate comprised of large non-cleaved cells, immunoblasts and small cleaved/non-cleaved cells. Focal areas of necrosis are present, and these are associated with a significant influx of neutrophils. Focal vasculitis is present in the lesion. No Reed-Sternberg cells are seen.

The mediastinal lymph node is largely replaced by a lymphomatous infiltrate similar to that described in the lung biopsy. However, there is less necrosis in this specimen, and some microscopic fields consist predominantly of large cells. EBER stains are strongly positive, and more so than in the lung specimen.

Insufficient unstained slides have been received for immunophenotypic studies, but tissue was sent for flow cytometry and gene rearrangements in the referral hospital.

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