RECURRENT EPSTEIN-BARR-VIRUS ASSOCIATED LESIONS IN ORGAN TRANSPLANT RECIPIENTS

Posttransplant lymphoproliferative disorders (PTLD) are related to Eps tein-Barr virus (EBV) and range from lymphoid hyperplasias to lymphoma s. The authors report 11 transplant recipients with recurrent EBV-asso ciated lesions. Four patients presented with EBV-positive mononucleosi s-like lymphadenitis. One had recurrence of a similar lesion and the o ther three developed polymorphic PTLDs. Matched clonal studies in one patient showed clonal lymphoid and EB viral populations in the recurre nt lesion, but not in the initial lesion. Six patients presented with polymorphic PTLDs. Five later developed histologically dissimilar tumo rs that resembled non-Hodgkin's lymphoma (two B-cell and one T-cell or igin), Hodgkin's disease (one patient), or smooth muscle tumor (one pa tient). Matched clonal studies were available from one patient and sho wed that the primary and recurrent lesions were clonally distinct. The sixth patient had recurrence of histologically and clonally identical polymorphic PTLD. One patient presented with monomorphic PTLD and dev eloped recurrence of a clonally identical tumor after a B-month remiss ion. This study shows that a few patients with EBV-associated lesions have clinical recurrence, which may be either a relapse of the origina l process or a new EBV-associated lesion. In some patients, the new le sion appeared to represent a more fully developed malignancy than did the antecedent lesion. Copyright (C) 1996 by W.B. Saunders Company.