Posttransplant lymphoproliferative disorders (PTLDs) present a wide clinicopathological spectrum, varying from the usual Epstein-Barr virus (EBV)-driven infectious mononucleosis-type polyclonal proliferations to EBV-positive or EBV-negative proliferations indistinguishable from overt lymphomas that occur in immunocompetent individuals. PTLDs characteristically have a predilection for extranodal sites and association with EBV.These disorders are usually B-cell type, although T-cell and rare cases involving both T- and B-cell types have also been described. The initial treatment consists in decreasing the immnosupressive therapy, usually with favorable results. The authors report on a rare case of a 19-year-old girl, with post—renal transplantation EBV-associated polymorphic lymphoproliferative gingival ulcerated lesions. To the best of their knowledge, this is the first case described in the English-language literature of polymorphic PTLD involving both B-cell and T-cell lineages, with an unusual immunoprofile affecting the mouth. The authors warn that this condition could be easily misdiagnosed as malignant lymphoma if not properly recognized.
Morovic A., Jaffe ES, Raffeld M., Schrager JA. Metachronous EBV-associated B-cell and T-cell posttransplant lymphoproliferative disorders in a heart transplant recipient. Am J Surg Pathol. 2009;33:149-154.
2.
Yin CC, Medeiros LJ, Abruzzo LV, et al. EBV-associated B- and T-cell posttransplant lymphoproliferative disorders following primary EBV infection in a kidney transplant recipient . Am J Clin Pathol. 2005;123:222-228.
3.
Srivastava T. , Zwick DL, Rothberg PG, Warady BAPosttransplant lymphoproliferative disorder in pediatric renal transplantation. Pediatr Nephrol. 1999;13:748-754.
4.
Hanson MN, Morrison VA, Peterson BA, et al. Posttransplant T-cell lymphoproliferative disorders: an aggressive, late complication of solid-organ transplantation. Blood. 1996; 88:3626-3633.
5.
Penn I.The changing pattern of posttransplant malignancies. Transplant Proc. 1991;23:1101-1103.
6.
Curtis RE, Travis LB, Rowlings PA, et al. Risk of lymphoproliferative disorders after bone marrow transplantation: a multi-institutional study. Blood. 1999;94:2208-2216.
7.
Swerdlow SH, Webber SA, Chadburn A., Ferry JAPosttransplant lymphoproliferative disorders. In: Swerdlow SH, Campo E, Harris NL, eds. WHO Classificationof Tumours: Pathology and Genetics of Tumours of Haematopoietic and Lymphoid Tissues. 4th ed. Lyon, France: IARC Press; 2008:343-351.
8.
Reams BD, McAdams HP, Howell DN, et al. Posttransplant lymphoproliferative disorder: incidence, presentation, and response to treatment in lung transplant recipients. Chest. 2003; 124:1242-1249.
9.
Chuhjo T., Yachie A., Kanegane H., et al. Epstein-Barr virus (EBV)-associated post-transplantation lymphoproliferative disorder simultaneously affecting both B and T cells after allogeneic bone marrow transplantation. Am J Hematol. 2003 ;72:255-258.
10.
Nelson BP, Locker J., Nalesnik MA, Fung JJ, Swerdlow SHClonal and morphological variation in a posttransplant lymphoproliferative disorder: evolution from clonal T-cell to clonal B-cell predominance. Hum Pathol. 1998;29:416-421.
11.
Hollingsworth HC, Stetler-Stevenson M., Gagneten D., et al. Immunodeficiency-associated malignant lymphoma: 3 cases showing genotypic evidence of both T- and B-cell lineages. Am J Surg Pathol. 1994;18:1092-1101.
12.
Euvrard S., Noble CP, Kanitakis J., et al. Brief report: successive occurrence of T-cell and B-cell lymphomas after renal transplantation in a patient with multiple cutaneous squamous-cell carcinomas. N Engl J Med. 1992;327:1924-1926.
13.
Frankel AH, Thompson M., Vulliamy T., et al. A T cell clone in association with an Epstein-Barr virus-related B cell lymphoma. Transplantation. 1991;52:1108-1109.
14.
Oda D., Persson GR, Haigh WG, et al. Oral presentation of posttransplantation lymphoproliferative disorders: an unusual manifestation. Transplantation. 1996;61:435-440.
15.
Portis T., Longnecker R.Epstein-Barr virus LMP2A interferes with global transcription factor regulation when expressed during B-lymphocyte development. J Virol. 2003;77:105-114.
16.
Stadlmann S., Fend F., Moser P., et al. Epstein-Barr virus-associated extranodal NK/T-cell lymphoma, nasal type of the hypopharynx, in a renal allograft recipient: case report and review of literature. Hum Pathol. 2001;32:1264-1268.
17.
Rolland SL, Seymour RA, Wilkins BS, Parry G., Thomason JMPost-transplant lymphoproliferative disorders presenting as gingival overgrowth in patients immunosuppressed with ciclosporin: a report of two cases. J Clin Periodontol. 2004;31:581-585.
18.
Ojha J., Islam N., Cohen DM, et al. Post-transplant lymphoproliferative disorders of oral cavity . Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2008;105:589-596.
19.
Hanto DW, Gajl-Peczalska KJ, Frizzera G., et al. Epstein-Barr virus (EBV) induced polyclonal and monoclonal B-cell lymphoproliferative diseases occurring after renal transplantation: clinical, pathologic, and virologic findings and implications for therapy. Ann Surg. 1983;198:356-369.
20.
Chang H., Wu JD, Cheng KK, Tseng HHEpstein-Barr virus-associated lymphoproliferative disorders in oral cavity after heart transplantation: report of a case. J Formos Med Assoc. 1994;93:332-336.
Raut A., Huryn J., Pollack A., Zlotolow I.Unusual gingival presentation of post-transplantation lymphoproliferative disorder: a case report and review of the literature. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2000;90:436-441.
23.
Keogh PV, Fisher V., Flint SRResolution of oral non-Hodgkin’s lymphoma by reduction of immunosuppressive therapy in a renal allograft recipient: a case report and review of the literature . Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2002;94:697-701.
24.
Steinberg MJ , Herrera AF, Barakat RGPosttransplant lymphoproliferative disorder resembling a chronic orocutaneous infection in an immunosuppressed patient . J Oral Maxillofac Surg. 2004;62:1033-1037.
25.
Bruce AJ, Subtil A., Rogers RS III, Castro LAMonomorphic Epstein-Barr virus (EBV)-associated large B-cell posttransplant lymphoproliferative disorder presenting as a tongue ulcer in a pancreatic transplant patient. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2006;102:24-28.
26.
Elad S., Meyerowitz C., Shapira MY, et al. Oral posttransplantation lymphoproliferative disorder: an uncommon site for an uncommon disorder. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2008;105:59-64.
27.
Oertel SH, Riess H.Antiviral treatment of Epstein-Barr virus-associated lymphoproliferations . Recent Results Cancer Res. 2002;159:89-95.
28.
Swinnen LJTreatment of organ transplant-related lymphoma. Hematol Oncol Clin North Am. 1997;11:963-973.
29.
Walker RC, Marshall WF, Strickler JG, et al. Pretransplantation assessment of the risk of lymphoproliferative disorder. Clin Infect Dis. 1995;20:1346-1353.
30.
Malnati MS, Dagna L., Ponzoni M., Lusso P.Human herpesvirus 8 (HHV-8/KSHV) and hematologic malignancies. Rev Clin Exp Hematol. 2003;7:375-405.
31.
Kapelushnik J., Ariad S., Benharroch D., et al. Post renal transplantation human herpesvirus 8-associated lymphoproliferative disorder and Kaposi’s sarcoma. Br J Haematol. 2001;113:425-428.
32.
Theate I., Michaux L., Squifflet JP, Martin A., Raphael M.Human herpesvirus 8 and Epstein-Barr virus-related monotypic large B-cell lymphoproliferative disorder coexisting with mixed variant of Castleman’s disease in a lymph node of a renal transplant recipient. Clin Transplant. 2003;17:451-454.
33.
Preiksaitis JK, Keay S.Diagnosis and management of posttransplant lymphoproliferative disorder in solid-organ transplant recipients. Clin Infect Dis. 2001;33(suppl 1):S38-S46.
34.
Caillard S. , Dharnidharka V., Agodoa L., Bohen E., Abbott K.Posttransplant lymphoproliferative disorders after renal transplantation in the United States in era of modern immunosuppression . Transplantation. 2005;80:1233-1243.
