CYTOLOGIC FEATURES OF POSTTRANSPLANT LYMPHOPROLIFERATIVE DISORDER

Post-transplant lymphoproliferative disorders (PTLD) are Epstein-Barr virus (EBV)-associated lymphoid proliferations which affect approximat ely 2% of organ allograft recipients. Although the histologic features of PTLD are well described, they have been described only rarely in c ytologic specimens. The cytomorphologic features of PTLD in body fluid specimens, needle aspirations and a gastric brushing specimen from se ven patients with histologically confirmed PTLD were therefore reviewe d. In the cytologic specimens, PTLD was characterized by a mostly poly morphous population of lymphoid cells containing many large transforme d lymphocytes, occasional immunoblast-like atypical lymphocytes, necro sis, and, frequently, obvious plasmacytoid differentiation. The presen ce of EBV was documented in five of the seven cases in the correspondi ng tissue biopsies. The four patients with PTLD in a body fluid specim en all died within 3 months of detection of the PTLD in the body fluid . The three remaining patients are alive with resolution of PTLD (foll ow-up of 7, 8, and 14 months). The diagnosis of PTLD should be suggest ed when cytologic specimens from organ allograft recipients show a pol ymorphous atypical lymphoid proliferation, frequently with plasmacytoi d differentiation and necrosis. Cytologic samples may provide the init ial diagnosis of this potentially fatal disease and allow appropriate intervention. The presence of PTLD in a body fluid specimen is a poor prognostic indicator. (C) 1997 Wiley-Liss, Inc.