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Classical Hodgkin lymphoma type post-transplant lymphoproliferative disorder in a kidney transplant recipient: a diagnostic pitfall

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Abstract

We report a case of classical Hodgkin lymphoma type post-transplant lymphoproliferative disorder (HL-PTLD) after kidney transplantation to highlight the difficulty of distinguishing this disorder from Hodgkin lymphoma-like PTLD (HL-like PTLD). Through this case report and literature review, we seek to clarify definitive pathologic features to differentiate these two conditions. A 38-year-old male kidney transplant recipient who had been receiving immunosuppressants was admitted to our hospital with unidentified high fever. Computed tomography images and blood tests indicated a lymphoproliferative disorder. Abdominal lymph node biopsy was performed, and microscopic examination revealed the presence of many large atypical cells in a background of dense T cell accumulation. The large, atypical cells were positive for Epstein–Barr Virus (EBV)-encoded small RNAs (EBER) in situ hybridization, EBV-LMP1, CD30 and PAX5, but negative for CD15, CD20 and CD45. Except for CD15-negativity, this immunohistochemical pattern was consistent with that of classical Hodgkin lymphoma. By close examination of the above immunoreactivities and the patient’s subsequent chemosensitive clinical course, we finally made a diagnosis of HL-PTLD.

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Acknowledgements

The authors thank Mr. Ben Phillis, Wakayama Medical University, for proofreading and editing the manuscript.

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Authors and Affiliations

  1. Department of Pathology, Takatsuki General Hospital, Takatsuki, 569-1192, Japan

    Taro Mohri, Yoshihiro Ikura, Asako Hirakoso, Kai Yoshimura, Hidetoshi Okabe & Yasuhiro Iwai

  2. Department of Pathology, Kobe University Graduate School of Medicine, Kobe, Japan

    Taro Mohri & Asako Hirakoso

  3. Department of Hematology, Takatsuki General Hospital, Takatsuki, Japan

    Masashi Okamoto

  4. Department of Hematology, Kyoto University Hospital, Kyoto, Japan

    Masakatsu Hishizawa & Akifumi Takaori-Kondo

  5. Department of Pathology and Laboratory Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan

    Seiichi Kato & Shigeo Nakamura

  6. Department of Pathology and Molecular Diagnostics, Aichi Cancer Center Hospital, Nagoya, Japan

    Seiichi Kato

Authors
  1. Taro Mohri
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  2. Yoshihiro Ikura
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  3. Asako Hirakoso
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  5. Masakatsu Hishizawa
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  6. Akifumi Takaori-Kondo
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  9. Kai Yoshimura
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  10. Hidetoshi Okabe
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  11. Yasuhiro Iwai
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Correspondence to Yoshihiro Ikura.

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Mohri, T., Ikura, Y., Hirakoso, A. et al. Classical Hodgkin lymphoma type post-transplant lymphoproliferative disorder in a kidney transplant recipient: a diagnostic pitfall. Int J Hematol 108, 218–227 (2018). https://doi.org/10.1007/s12185-018-2410-x

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  • DOI: https://doi.org/10.1007/s12185-018-2410-x

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