COMBINED FINE-NEEDLE ASPIRATION BIOPSY, AND IMMUNOPHENOTYPIC AND CENOTYPIC APPROACH TO POSTTRANSPLANTATION LYMPHOPROLIFERATIVE DISORDERS

OBJECTIVE: To report our experience with a combined approach to posttr ansplant lymphoproliferative disorders (PT-LPDs) that utilizes fine ne edle aspiration biopsy. STUDY DESIGN: A review of the files in the Dep artment of Pathology, Saint Louis University Health Sciences Center, f rom 1988 to 1996 identified six patients with a diagnosis of PT-LPD wh o underwent either percutaneous or radiologically guided fine needle a spiration biopsy (FNAB). In all cases, material was collected for cyto morphology, flow cytometric analysis and, in selected cases, DNA polym erase chain reaction (PCR). Subsequent evaluations and clinical outcom es were obtained from the medical record. RESULTS: The six transplant recipients (4 men and 2 women; 3 cardiac, 2 renal and 1 hepatic transp lant) had these six patients had a polymorphic pattern of lymphoid cel ls with varying sizes. By flow cytometry, two were monoclonal, while f our had a polyclonal pattern. DNA PCR analysis on two FNABs demonstrat ed a monoclonal rearrangement of the immunoglobulin heavy chain gene. CONCLUSION: FNAB provides cytomorphologic characterization of PT-LPDs in transplantation patients and sufficient material for successful use of flow cytometry immunophenotyping and DNA PCR analysis. FNAB, there fore, has an important role in the evaluation of organ transplantation patients and is a valuable tool for assessing and diagnosing PT-LPD.