Late Epstein-Barr virus infection of a hepatosplenic gamma delta T-cell lymphoma arising in a kidney transplant recipient

Background and Objectives. gamma delta T-cell lymphomas am only exceptional ly observed in transplanted patients. Aim of this study was the detailed ch aracterization of one such case. Design and Methods, The patient developed spontaneous splenic rupture six y ears after kidney transplantation. The splenic red pulp was Infiltrated by medium-sized and large lymphoid cells with two or more nucleoli, At autopsy , similar lymphoid cells Infiltrated the hepatic sinusoids, Histologic, imm unologic and molecular studies were carried out. Results. By immunohistochemistry, the atypical lymphoid cells were found to express CD3, CD45 and indicating their T-lineage origin. Approximately; 99 % of spleen mononuclear cells (MNC) were CD3(+), gamma delta TcR+, CD4-, CD S, alpha beta TcR-. A clonal gamma delta TcR rearrangement (V gamma 1-J gam ma 1.3/2.3-C gamma 2; V delta 1-D delta 2-J delta 1) was detected. The fina l diagnosis was peripheral T-cell lymphoma, hepato-splenic gamma delta-type . EBV infection of spleen MNC was documented by molecular studies However, in situ hybridization for EBER-1 (EBV-RNA) showed that only a minority of m alignant lymphoid cells (5=7%) were EBV-infected, Interpretation and conclusions, It is concluded that EBV Infection was as a late event involving an already transformed gamma delta T-cell clone, (C) 2000, Ferrata Storti Foundation.