Epstein-Barr virus-positive T-cell lymphoma characterized by intestinal involvement with multiple perforation in an adult renal allograft recipient: two case reports
Pelin Bayik1, B. Handan Ozdemir1, Gonca Ozgun1, Fazilet Kayaselcuk1, Sedat Yildirim2, Mehmet Haberal2.
1Department of Pathology, Baskent University, Ankara, Turkey; 2Department of General Surgery, Division of Transplantation, Baskent University, Ankara, Turkey
Introduction: Post-transplant lymphoproliferative disorder (PTLD) is a relatively common post-transplantation malignancy affecting as frequently as 10% of all solid organ recipients. Most PTLDs are of B cell origin with a common Epstein-Barr virus (EBV) association. T-cell PTLDs are much rarer and less frequently associated with EBV. Here we report two unusual cases of EBV-positive T cell lymphomas causing intestinal ulceration and perforation in adult renal transplant recipients.
Cases: The first case is a fifty-two-year-old male with renal allograft who developed cryptogenic end-stage liver failure and was accepted as a candidate for liver transplantation. Meanwhile, he was admitted with severe abdominal pain, which resulted from ileal perforation. Pathologic evaluation of the intestinal resection showed diffuse malignant lymphoid infiltration of the ileum, which was consistent with anaplastic large cell lymphoma (ALCL). The tumor was positive for the Epstein-Barr virus (EBV) genome. The second case is a forty-seven-year-old male renal allograft recipient who developed acute abdomen in the 8th year of his transplantation. Explorative surgery revealed diffuse intestine involvement and large bowel involvement with EBV positive NK/T cell lymphoma.
Conclusion: T and NK/T cell lymphomas are rare forms of PTLDs, which are infrequently associated with EBV. This extraordinary form of PTLD, which shows an unexpected clinic such as bowel involvement and perforation in a late post-transplant period and EBV positivity, represents a rare clinic entity.
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