Whether lymphoproliferative disorders arising in immunosuppressed recipients of organ transplants are primarily neoplastic or hyperplastic in nature is a matter of controversy. Reports of polyclonal B-cell proliferations in these lesions suggest the presence of hyperplasia, but these disorders resemble lymphoma histologically and are clinically aggressive and often rapidly fatal, as expected of a malignant neoplastic disease. We examined tissue specimens from 10 cases of lymphoproliferative disease that occurred in immunosuppressed recipients of cardiac transplants. Specimens from nine of these patients lacked cellular immunoglobulin; however, analysis of DNA extracted from these tissues revealed that each lesion contained large numbers of cells possessing uniform, clonal rearrangements of immunoglobulin-gene DNA. Therefore, when first seen clinically these proliferations contained a notable monoclonal-cell population typical of conventional B-cell lymphomas that are not associated with immunosuppression. We therefore suggest that lymphoproliferative disorders in recipients of cardiac transplants are neoplastic at the earliest stages of detectable disease.
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Podolsky, D. K., Gonzalez, R. G., Hasserjian, R. P.
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[Full Text]
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(2003). Antigen- and/or immune-driven lymphoproliferative disorders. Ann Oncol
14: 1595-1606
[Full Text]
Sanchez, M.-L., Almeida, J., Gonzalez, D., Gonzalez, M., Garcia-Marcos, M.-A., Balanzategui, A., Lopez-Berges, M.-C., Nomdedeu, J., Vallespi, T., Barbon, M., Martin, A., de la Fuente, P., Martin-Nunez, G., Fernandez-Calvo, J., Hernandez, J.-M., Miguel, J. F. S., Orfao, A.
(2003). Incidence and clinicobiologic characteristics of leukemic B-cell chronic lymphoproliferative disorders with more than one B-cell clone. Blood
102: 2994-3002
[Abstract][Full Text]
Schoen, F. J., Padera, R. F. Jr.
(2003). Cardiac Surgical Pathology. Card Surg Adult
2: 119-185
[Full Text]
Lemoine, A., Pham, P., Azoulay, D., Saliba, F., Emile, J.-F., Saffroy, R., Broet, P., Bismuth, H., Samuel, D., Debuire, B.
(2001). Detection of gammopathy by serum protein electrophoresis for predicting and managing therapy of lymphoproliferative disorder in 911 recipients of liver transplants. Blood
98: 1332-1338
[Abstract][Full Text]
Huang, C. A., Fuchimoto, Y., Gleit, Z. L., Ericsson, T., Griesemer, A., Scheier-Dolberg, R., Melendy, E., Kitamura, H., Fishman, J. A., Ferry, J. A., Harris, N. L., Patience, C., Sachs, D. H.
(2001). Posttransplantation lymphoproliferative disease in miniature swine after allogeneic hematopoietic cell transplantation: similarity to human PTLD and association with a porcine gammaherpesvirus. Blood
97: 1467-1473
[Abstract][Full Text]
Cho, Y.-G., Ramer, J., Rivailler, P., Quink, C., Garber, R. L., Beier, D. R., Wang, F.
(2001). An Epstein-Barr-related herpesvirus from marmoset lymphomas. Proc. Natl. Acad. Sci. USA
98: 1224-1229
[Abstract][Full Text]
Demols, P F, Cochaux, P M, Velu, T, Caspers-Velu, L
(2001). Chorioretinal post-transplant lymphoproliferative disorder induced by the Epstein-Barr virus. Br J Ophthalmol
85: 93-95
[Abstract][Full Text]
Swinnen, L. J.
(2000). Post-transplant Lymphoproliferative Disorders: Implications for Acquired Immunodeficiency Syndrome-Associated Malignancies. J Natl Cancer Inst Monogr
2000: 38-43
[Abstract][Full Text]
Farrell, R J, Ang, Y, Kileen, P, O'Briain, D S, Kelleher, D, Keeling, P W N, Weir, D G
(2000). Increased incidence of non-Hodgkin's lymphoma in inflammatory bowel disease patients on immunosuppressive therapy but overall risk is low. Gut
47: 514-519
[Abstract][Full Text]
Pickhardt, P. J., Siegel, M. J., Hayashi, R. J., Kelly, M.
(2000). Posttransplantation Lymphoproliferative Disorder in Children: Clinical, Histopathologic, and Imaging Features. Radiology
217: 16-25
[Abstract][Full Text]
Cesarman, E., Chadburn, A., Liu, Y.-F., Migliazza, A., Dalla-Favera, R., Knowles, D. M.
(1998). BCL-6 Gene Mutations in Posttransplantation Lymphoproliferative Disorders Predict Response to Therapy and Clinical Outcome. Blood
92: 2294-2302
[Abstract][Full Text]
Ritter, J. H., Wick, M. R.
(1994). Posttransplant Lymphoproliferative Disorders: Immunohistologic Differential Diagnosis With Severe Allograft Rejection. INT J SURG PATHOL
2: 105-115
[Abstract]
Fearon, E., Hamilton, SR, Vogelstein, B
(1987). Clonal analysis of human colorectal tumors. Science
238: 193-197
[Abstract]
Myer, C. M. III, Reilly, J. S.
(1985). Airway Obstruction in an Immunosuppressed Child. Arch Otolaryngol Head Neck Surg
111: 409-411
[Abstract]
Cleary, M., Epstein, M., Finerty, S, Dorfman, R., Bornkamm, G., Kirkwood, J., Morgan, A., Sklar, J
(1985). Individual tumors of multifocal EB virus-induced malignant lymphomas in tamarins arise from different B-cell clones. Science
228: 722-724
[Abstract]
WALDMANN, T. A., KORSMEYER, S. J., BAKHSHI, A., ARNOLD, A., KIRSCH, I. R.
(1985). Molecular Genetic Analysis of Human Lymphoid Neoplasms: Immunoglobulin Genes and the c-myc Oncogene. ANN INTERN MED
102: 497-510
[Abstract]
Vogelstein, B, Fearon, E., Hamilton, SR, Feinberg, A.
(1985). Use of restriction fragment length polymorphisms to determine the clonal origin of human tumors. Science
227: 642-645
[Abstract]
COHEN, D. J., LOERTSCHER, R., RUBIN, M. F., TILNEY, N. L., CARPENTER, C. B., STROM, T. B.
(1984). Cyclosporine: A New Immunosuppressive Agent for Organ Transplantation. ANN INTERN MED
101: 667-682
[Abstract]
MARTIN, P. J., SHULMAN, H. M., SCHUBACH, W. H., HANSEN, J. A., FEFER, A., MILLER, G., THOMAS, E. D.
(1984). Fatal Epstein-Barr-Virus-Associated Proliferation of Donor B Cells After Treatment of Acute Graft-Versus-Host Disease with a Murine Anti-T-Cell Antibody. ANN INTERN MED
101: 310-315
[Abstract]
WADE, J. L. III, TAYLOR, J. R., ULTMANN, J. E.
(1984). Diffuse Immunoblastic Sarcoma from Benign Lymphoid Proliferation. ANN INTERN MED
100: 765-765
[Abstract]
