Primary central nervous system posttransplant lymphoproliferative disorders

被引:105
作者
Castellano-Sanchez, AA
Li, SY
Qian, J
Lagoo, A
Weir, E
Brat, DJ
机构
[1] Washington Univ, Sch Med, Dept Pathol & Immunol, St Louis, MO 63110 USA
[2] Washington Univ, Sch Med, Dept Lab Med, St Louis, MO 63110 USA
[3] Emory Univ, Sch Med, Atlanta, GA 30322 USA
[4] Albany Med Coll, Albany, NY 12208 USA
[5] Duke Univ, Durham, NC USA
[6] Johns Hopkins Univ, Sch Med, Baltimore, MD USA
关键词
posttransplant lymphoproliferative disorder; PTLD; lymphoma; brain tumor; transplantation; immunosuppression; Epstein-Barr virus;
D O I
10.1309/N82CTQ1J0XEVEFQ8
中图分类号
R36 [病理学];
学科分类号
100104 ;
摘要
Posttransplant lymphoproliferative disorders (PTLDs) represent a spectrum ranging from Epstein-Barr virus (EBV)-driven polyclonal lymphoid proliferations to EBV+ or EBV- malignant lymphomas. Central nervous system (CNS) PTLDs have not been characterized fully. We reviewed the clinical, radiologic, and pathologic features of 12 primary CNS PTLDs to define them more precisely. Patients included 10 males and 2 females (median age, 43.4 years) who were recipients of kidney (n = 5), liver (n = 2), heart (n = 2), peripheral blood stem cells (n = 2), or bone marrow (n = 1). All received immunosuppressive therapy. CNS symptoms developed 3 to 131 months (mean, 31 months) after transplantation. By neuroimaging, most showed multiple (3 to 9) intra-axial, contrast-enhancing lesions. Histologic sections showed marked expansion of perivascular spaces by large, cytologically malignant lymphoid cells that were CD45+, CD20+, EBV+ and showed light chain restriction or immunoglobulin gene rearrangement. In distinction to PTLDs in other organ systems, CNS PTLDs were uniformly high-grade lymphomas that fulfilled the World Health Organization criteria for monomorphic PTLDs. Extremely short survival periods were noted for each CNS PTLD that followed peripheral blood stem cell transplantation. Survival of others with CNS PTLD varied; some lived more than 2 years.
引用
收藏
页码:246 / 253
页数:8
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