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Published on: April 10, 2014
Histologic, molecular, and radiologic characterization of resolving cerebral posttransplant lymphoproliferative
A F Dean1, T C Diss, A C Wotherspoon
1Department of Neuropathology, Institute of Psychiatry, De Crespigny Park, London, United Kingdom.
Insights
Combining immunocytochemistry and PCR on minimal tissue maximizes diagnostic yield for central nervous system lymphoproliferative disorders (LPDs) in pediatric transplant patients. This approach aids in identifying LPD characteristics and guiding treatment decisions.
Area of Science:
- Neuroscience
- Immunology
- Oncology
Background:
- Lymphoproliferative disorders (LPDs) are more prevalent in pediatric immunosuppressed transplant recipients and often affect the central nervous system (CNS).
- Biopsy justification in CNS LPDs hinges on diagnostic yield, particularly in pediatric transplant cases.
Observation:
- A 12-year-old renal transplant patient presented with multifocal cerebral LPD, undergoing serial MRI and stereotactic biopsy.
- The biopsy utilized immunocytochemistry and polymerase chain reaction (PCR) to analyze cellular infiltrates.
- MRI documented signal changes during clinical recovery, noting persistent abnormalities at non-biopsied sites.
Findings:
- Combined immunocytochemistry and PCR identified immunophenotype, lineage, clonality, viral involvement, and cellular origin in minimal biopsy tissue.
- A novel LPD pattern revealed numerous benign T cells obscuring a small B cell clone.
- PCR analysis confirmed the B cell clonality, indicating an underlying B cell lesion.
Implications:
- Stereotactic biopsies combined with PCR offer maximal diagnostic information for CNS LPDs, even with limited tissue.
- A T cell infiltrate warrants further investigation for an underlying B cell lesion.
- Serial MRI can track LPD resolution, but residual signal abnormalities highlight the need for comprehensive diagnostic methods.
Abstract:
Lymphoproliferative disorders (LPDs) are commoner in pediatric versus adult immunosuppressed transplant recipients, and frequently involve the central nervous system. In these circumstances, the justification for biopsy is heavily influenced by the likely diagnostic yield. The present study centers on a 12-y-old renal transplant patient who developed multifocal cerebral LPD and had serial magnetic resonance (MR) examinations during the course of her illness from which she has completely recovered upon reduction of immunosuppression. She underwent stereotaxic biopsy, which was analyzed by both immunocytochemistry and polymerase chain reaction to examine the general question of how to release the maximum amount of information contained within, as well as to obtain a tissue diagnosis in this particular case. We show that a combination of these methods permits identification of the immunophenotype, lineage, clonality, viral involvement, and origin of abnormal cellular infiltrates. The biopsy also showed a novel histologic pattern of LPD, comprising numerous benign T cells obscuring a tiny clone of B cells. The MR examinations documented, for the first time, the differences in signal that accompany clinical resolution at both biopsied and nonbiopsied sites, showing that the latter may be associated with reduction, but not elimination, of MR signal abnormality. We conclude: 1) a combination of conventional and polymerase chain reaction analysis offers the greatest diagnostic yield from stereotaxic biopsies, even when the available tissue is minimal; 2) a focal polyclonal T cell infiltrate should prompt further investigation to exclude an underlying B cell lesion.
