Classical Hodgkin lymphoma-type and monomorphic-type post-transplant lymphoproliferative disorder following liver transplantation: a case report.
Classical Hodgkin lymphoma-type and monomorphic-type post-transplant lymphoproliferative disorder following liver transplantation: a case report.
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DOI：
10.1186/s40792-018-0480-x
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发表时间：
2018-07-06
影响因子：
0.8
通讯作者：
Sasano H
中科院分区：
文献类型：
--
作者：
Kumata H;Nakanishi C;Murakami K;Miyagi S;Fukuhara N;Carreras J;Nakamura N;Ichinohasama R;Unno M;Kamei T;Sasano H
移植后淋巴组织增生性疾病（PTLD）是一种危及生命的并发症，难以治疗;此外，病理生理类型的确定也很困难。我们报告了一例罕见的病例，患者在活体肝移植（LDLT）后发生了两种类型的EB病毒（EBV）阴性PTLD。一名64岁男性因急性暴发性B型肝炎接受LDLT。65个月后，他患上了EBV阴性单形性B细胞PTLD。减少免疫抑制治疗和利妥昔单抗化疗导致部分反应。他接受了钇-90-替伊莫单抗放射免疫治疗，对所有病变均有效，但脾门病变除外，该病变扩大并似乎穿透了胃。因此，他接受了胰尾切除术，脾切除术和胃部分切除术。病理诊断为EBV阴性经典型霍奇金淋巴瘤（cHL）型PTLD。从临床和病理学角度来看，该患者表现出意外的PTLD病程。既往无EBV阴性cHL型PTLD与EBV阴性单形性B细胞PTLD共存的成人病例报告。当一个奇怪的和难治性的病变持续存在，尽管有效的治疗PTLD，我们必须考虑的可能性，另一种类型的PTLD的残留病变。
Post-transplant lymphoproliferative disorder (PTLD) is a life-threatening complication that can be difficult to treat; moreover, determination of the pathophysiological type is difficult. We report a rare case of a patient who developed two types of Epstein–Barr virus (EBV)-negative PTLD following living donor liver transplantation (LDLT). A 64-year-old man underwent LDLT for acute fulminant hepatitis B. Sixty-five months later, he developed EBV-negative monomorphic B cell PTLD. Reduction of immunosuppressive therapy and chemotherapy with rituximab resulted in a partial response. He received radioimmunotherapy with yttrium-90-ibritumomab tiuxetan, which was effective for all lesions, except for the splenic hilar lesion, which enlarged and seemed to penetrate the stomach. Therefore, he underwent resection of the pancreatic tail with splenectomy and partial gastrectomy. The pathological diagnosis was EBV-negative classical Hodgkin lymphoma (cHL)-type PTLD. This patient showed an unexpected course of PTLD, from both a clinical and pathological perspective. There are no prior reports of an adult case of EBV-negative cHL-type PTLD coexisting with EBV-negative monomorphic B cell PTLD. When a strange and refractory lesion persists despite effective therapy for PTLD, we must consider the possibility of another type of PTLD within the residual lesion.