PTLD Class 1997

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

Reference

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

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

Please mail comments, corrections or suggestions to the TPIS administration at the UPMC.

[FRAMES] [NO FRAMES]