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Isolated pleural PTLD after cardiac transplantation
Manisha Lamba1, Maha Jabi, Ruth Padmore
1Department of Pathology and Laboratory Medicine, Ottawa Hospital, General Campus, 501 Smyth Road, Ottawa, Ontario K1H 8L6, Canada. mlamba@ottawahospital.on.ca
Summary
This case study highlights a rare instance of posttransplant lymphoproliferative disorder (PTLD) affecting the pleura. Diagnosis was aided by cytology, immunophenotyping, and molecular studies, confirming Epstein-Barr virus (EBV) involvement.
Area of Science:
- Oncology
- Virology
- Transplant Medicine
Background:
- Posttransplant lymphoproliferative disorders (PTLD) are associated with Epstein-Barr virus (EBV) infection and immunosuppression in transplant recipients.
- PTLD typically affects lymphoid organs but can manifest in extranodal sites.
Observation:
- A 62-year-old male cardiac transplant recipient developed dyspnea and pleural effusions seven years post-transplant.
- Imaging revealed pleural thickening; cytology was suggestive of PTLD.
Findings:
- Autopsy confirmed bilateral pleural nodules, immunohistochemistry showed B-cell lineage, and PCR detected EBV DNA in pleural nodules.
- Molecular studies indicated a shift from monoclonal to oligoclonal IgH gene rearrangement after treatment.
Implications:
- Pleural-based PTLD is a rare entity requiring integrated diagnostic approaches.
- This case underscores the role of EBV in PTLD pathogenesis and the utility of molecular diagnostics.
- Treatment strategies, including withdrawal of immunosuppression and targeted therapies, are crucial for managing PTLD.