B-cell post-transplant lymphoproliferative disorder isolated to the central nervous system is EBV-positive and lacks p53 and Myc expression by immunohistochemistry

Publication date: Available online 16 December 2016
Source:Human Pathology
Author(s): Andrew Sundin, Bartosz J. Grzywacz, Sophia Yohe, Michael A. Linden, Elizabeth L. Courville
In this retrospective study from one institution, we performed a clinicopathologic study of a cohort of patients with post-transplant lymphoproliferative disorder (PTLD) confined to the central nervous system. We also identified a comparison cohort of patients with de novo primary diffuse large B-cell lymphoma of the central nervous system. We performed a detailed morphologic review, evaluated Epstein–Barr Virus (EBV) by in-situ hybridization, and interpreted a panel of immunohistochemical stains in a subset of cases including Hans classification markers (CD10, BCL6, MUM1), p53, CD30, myc, and BCL2. All 17 of the post-transplant and none of the 11 de novo cases were EBV-positive (P<.005). Morphologic patterns identified in the PTLD cases were monomorphic diffuse large B-cell lymphoma pattern (10 patients) and "T-cell rich" pattern (7 patients). The monomorphic post-transplant cases were more likely to be myc negative (P=.015) and CD30 positive (P<.005) than the de novo cases, and showed a similarly low rate of p53 positivity by immunohistochemistry. No prognostic factors for overall survival were identified. Central nervous system PTLD is EBV positive, typically lacks p53 and myc expression by immunohistochemistry, and can present with numerous background T-lymphocytes.



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