Cytologic features of post-transplant lymphoproliferative disorder

Post-transplant lymphoproliferative disorders (PTLD) are Epstein-Barr virus (EBV)-associated lymphoid proliferations which affect approximately 2% of organ allograft recipients. Although the histologic features of PTLD are well described, they have been described only rarely in cytologic specimens. The cytomorphologic features of PTLD in body fluid specimens, needle aspirations, and a gastric brushing specimen from seven patients with histologically confirmed PTLD were therefore reviewed. In the cytologic specimens, PTLD was characterized by a mostly polymorphous population of lymphoid cells containing many large transformed lymphocytes, occasional immunoblast-like atypical lymphocytes, necrosis, and, frequently, obvious plasmacytoid differentiation. The presence of EBV was documented in five of the seven cases in the corresponding tissue biopsies. The four patients with PTLD in a body fluid specimen all died within 3 months of detection of the PTLD in the body fluid. The three remaining patients are alive with resolution of PTLD (follow-up of 7, 8, and 14 months). The diagnosis of PTLD should be suggested when cytologic specimens from organ allograft recipients show a polymorphous atypical lymphoid proliferation, frequently with plasmacytoid differentiation and necrosis. Cytologic samples may provide the initial diagnosis of this potentially fatal disease and allow appropriate intervention. The presence of PTLD in a body fluid specimen is a poor prognostic indicator.