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Int J Clin Exp Pathol 2013;6(12):3009-3013

Case Report
Post cardiac transplantation T-cell lymphoproliferative disorder presenting as a solitary
lung nodule

Barina Aqil, Bhuvaneswari Krishnan, Choladda V Curry, M Tarek Elghetany, Reka Szigeti

Department of Pathology & Immunology, Baylor College of Medicine, Department of Pathology, Section of Hematopathology, Texas Children’s
Hospital, Department of Pathology, Michael E. DeBakey VA Medical Center, Houston, Texas, USA

Received September 14, 2013; Accepted September 29, 2013; Epub November 15, 2013; Published December 1, 2013

Abstract: Post-transplantation lymphoproliferative disorder (PTLD) is an infrequent, but serious complication of solid organ and bone marrow
transplantations. The vast majority of the cases are of B-cell origin and usually associated with Epstein-Barr virus (EBV) infection. The non-B (T
and NK cell) PTLDs account for up to 14% of the PTLD cases in Western countries. We report a case of a 66-year-old man who received an
orthotopic heart transplant for cardiomyopathy 7 years prior to presentation. He was referred to our institution with a hypermetabolic solitary
right lower lobe lung nodule with an SUV of 9.2 on PET scan. The combined histomorphological and immunohistochemical pattern was most
consistent with monomorphic PTLD, peripheral T-cell lymphoma with angioimmunoblastic features. Molecular studies showed clonal T-cell
gamma receptor gene rearrangement. Primary pulmonary involvement of T-cell PTLD is extremely rare. This is the third reported case of T-cell
PTLD after cardiac transplantation, primarily involving the lung. Further, studies will be required to determine the appropriate treatment and
prognosis of this rare entity. (IJCEP1309042).

Keywords: PTLD, T-cell lymphoma, lung nodule, heart transplantation

Address correspondence to: Dr. Reka Szigeti or Barina Aqil, Department of Pathology & Immunology, Baylor College of Medicine, One Baylor
Plaza, Houston, TX 77030. Tel: 713-873-3205; Fax: 713-873-3214; E-mail: rgsziget@bcm.edu (RS); aqil@bcm.edu (BA)