Table 624

Early/Benign PTLD

Plasmacytic or atypical lymphoid hyperplasia Infectious mononucleosis-like syndrome

- Nodal disease with preservation

- <3 months posttransplantation

- Polyclonal

Polymorphic PTLD

- Nodal disease with effacement of lymph node architecture or extranodal disease

- Full range of B-cell maturation

- Monoclonal

- Normal cytogenetics

- No oncogene mutations

Monomorphic PTLD (Non-Hodgkin's B- or T-Cell lymphoma)

- Nodal disease with effacement of lymph node architecture or invasive extranodal disease

- Monomorphic sheets of transformed B cells

- Monoclonal

- Some with abnormal cytogenetics or mutations in ras or p53

PTLD-Other

T-cell-rich, large B-cell (Hodgkin's-like) lymphoma

- Nodal disease

- Background of small T-cells with superimposed Reed-Sternberg-like cells

- Monoclonal Plasmacytoma-like lesions

- Nodal disease with effacement of lymph node architecture by mature plasma cells with monoclonal immunoglobulin

- Monoclonal Multiple myeloma

Criteria For Evaluation of Clonality (Specify B or T Cell) CO Polyclonal

C1 Monoclonal-not further categorized C1a Monoclonal component estimated at <50% of cells C1b Monoclonal component estimated at >50% of cells C1c Multiclonal or oligoclonal pattern CX not evaluated

Criteria For Evaluation of EBV within PTLD (detection by EBER2 or LMP1 expression) E0 EBV negative

E1 EBV Present-not further categorized E1a Nonclonal viral pattern E1b Clonal viral pattern EX not evaluated

Finally, they recommended that the classification system formulated by Harris et al.36 be used (Table 62.3) with supplemental information (clonality, EBV status) appended to the histological diagnosis of PTLD. The World Health Organization (WHO) also defined several categories of PTLD (Table 62.4).

Although no specific staging system for PTLD exists, the consensus group recommended that the Ann Arbor Staging Classification with Cotswold modifications be used.

Table 62.4 World Health Organization categories of PTLD

WHO Categories of Posttransplant lymphoproliferative disorders

Early lesions Reactive plasmacytic hyperplasia Infectious mononucleosis-like PTLD polymorphic Polyclonal (rare) Monoclonal

PTLD monomorphic (classify according to lymphoma classification) B-cell lymphomas Diffuse large B-cell lymphoma (immunoblastic, centroblastic, anaplastic) Burkitt/Burkitt-like lymphoma Plasma cell myeloma T-cell lymphomas

Peripheral T-cell lymphoma, not otherwise categorized Other types (Hepatosplenic, gamma-delta, T/NK) Other types (rare)

Hodgkin's disease—like lesions (associated with methotrexate therapy) Plasmacytoma-like lesions

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