POSTTRANSPLANT CD30 (KI-1)-POSITIVE ANAPLASTIC LARGE-CELL LYMPHOMA - REPORT OF A CASE WITH PRESENTATION AS A PLEURAL EFFUSION

BACKGROUND: Posttransplant lymphoproliferative disorders (PTLDs) are a lmost always of B-cell derivation and have a strong association with E pstein-Barr virus (EBV). Only rare cases Of CD30 (Ki-1)-positive anapl astic large cell (ALC) lymphomas in transplant recipients have been de scribed. EBV has been studied in few of these cases. Pleural effusion is an uncommon clinical manifestation of both PTLDs and CD30-positive ALC lymphoma. CASE: A 60-year-old, male renal transplant recipient pre sented with fever and pleural effusion. Cytologic examination of the e ffusion revealed a large cell lymphoma. Immunocytologic studies disclo sed a T-cell phenotype. Subsequently a cutaneous lesion and an accesso ry spleen were observed, and cervical lymphadenopathies developed. Fin e needle aspiration of lymph nodes confirmed the presence of lymphoma. Histologic and immunohistochemical studies of the lymph nodes, skin a nd accessory spleen revealed the presence of CD30-positive, T-cell, AL C lymphoma. No EBV DNA was detected by polymerase chain reaction analy sis. Despite chemotherapy, the patient died seven months after the ini tial cytologic diagnosis of lymphoma. CONCLUSION: CD30-positive ALC ly mphomas ape an uncommon variant of PTLDs that should be considered in the differential diagnosis of neoplastic disorders arising in immunosu ppressed patients. Cytology and immunocytochemistry are useful diagnos tic procedures for their early detection.