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Hodgkin's disease occurring in a child after liver transplantation
V Conter1, B Tschümperlin, B Gridelli
1Clinica Pediatrica, Ospedale S. Gerardo di Monza, University of Milan, Italy. masera@xquasar.it
Insights
This is the first reported case of classical Hodgkin's disease (HD) in a liver transplant recipient. The Epstein-Barr virus association suggests immunosuppression may play a role in its development.
Area of Science:
- Oncology
- Transplantation Immunology
- Virology
Background:
- Liver transplantation is a life-saving procedure for end-stage liver disease.
- Post-transplant lymphoproliferative disorders (PTLD) are a known complication, but classical Hodgkin's disease (HD) is rare.
- Immunosuppression is necessary to prevent organ rejection but increases cancer risk.
Observation:
- A 14-year-old boy, 7 years post-liver transplant for biliary atresia, developed cervical lymphadenopathy.
- Biopsy revealed classical Hodgkin's disease (mixed cellularity type), with neoplastic cells positive for CD30, CD15, LMP1, and EBER1/2.
- The patient received ABVD chemotherapy and radiotherapy, achieving complete remission.
Findings:
- This is the first documented case of classical Hodgkin's disease following liver transplantation.
- The presence of Epstein-Barr virus (EBV)-encoded RNA (EBER1/2) and latent membrane protein 1 (LMP1) in neoplastic cells suggests a potential role for EBV in HD pathogenesis in this context.
- The patient achieved complete remission after standard Hodgkin's lymphoma treatment.
Implications:
- The findings suggest a possible link between long-term immunosuppression and the development of classical Hodgkin's disease.
- Further research is needed to understand the role of immunosuppression and EBV in post-transplant lymphomagenesis.
- This case highlights the importance of vigilant monitoring for malignancies in organ transplant recipients.
Abstract:
Here we describe the case of a 14-year-old boy who underwent liver transplantation for post-Kasai biliary atresia when aged 4. Antirejection treatment consisted of prednisone and cyclosporine. At the age of 11 years the patient developed left cervical lymphadenopathy; the biopsy showed classical Hodgkin's disease(HD) of the mixed cellularity (MC) type. Neoplastic cells expressed CD30 and CD15, and were negative for CD45, CD20, CD3, CD43, and CD79a. Furthermore, they carried the EBV-related products LMP1 and EBER1/2. Treatment consisted of three cycles of adriamycin, bleomycin, vinblastine and DTIC (ABVD), followed by radiotherapy (2,000 cGys) on involved fields. At present, 42 months after the diagnosis of HD, the patient is still in complete remission. This is, to the best of our knowledge, the first reported case of classical HD following liver transplantation. The positivity of neoplastic cells for LMP1 and EBER1/2 indicates a possible role for immunosuppression in the development of the tumor, and whether a reduction in immunosuppression might have influenced the course of the disease is open to question.