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Article Review/Hyperlink
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Anderson L, Papadimetriou JC, Kuo PC, Johnson LB, Klassen DK,
Hoehn-Saric E, Weir MR, Bartlett ST
Histopathology of renal posttransplant lymphoproliferation:
comparison with rejection using the Banff Schema
Am J Kidney Dis
(Oct) 28:578-584 1996

One of the more difficult and more important distinctions to be
made in evaluating the histopathology of renal transplant biopsies is
the differentiation between severe acute rejection and post transplant
lymphoproliferative disease. Part of the difficulty arises from the
fact that both entities can be present simultaneously. It is just
this specific problem that has been addressed in this study from the
extensive transplant experience at the University of Pittsburgh.
The authors were able to compare nine examples of PTLD documented by
Epstein-Barr virus in situ hybridization and analysis of B cell
lineage with nine allograft nephrectomies classified as severe acute
rejection using the
Banff Schema. The authors focus on those features
which can be considered to be characteristic of PTLD rather than on
the absence of features characteristic of rejection.
PTLD as a
neoplastic or pre-neoplastic process is characterized by features
which are typical of lymphomas, namely space occupying expansile
infiltrates which push apart the tubular architecture rather than
invading the parenchyma and the presence of nuclear atypia in the
pleomorphic lymphocytic infiltrate. Another feature which the authors
bring to attention is something which they term serpiginous necrosis
which is essentially foci of central necrosis within the expansile
nodules of neoplastic tissue. This is a feature which in my personal
experience has not been prominent in needle biopsies as is suggested
by this report where it was seen in nine out of nine cases of PTLD.
It is also of interest that some degree of tubulitis was also
identified in all of the patients with PTLD, suggesting the possibility
of either a concurrence of rejection and the lymphoproliferative
process or, as the authors hypothesize, a reflection of the infiltrative
potential of the PTLD cells.
Comment: The study is of importance in
highlighting those features of PTLD which can be evaluated early in
needle biopsy specimens to raise the suspicion of the presence of PTLD
pending confirmatory results of immunophenotyping and in situ
hybridization.
(Michael Kashgarian MD, Yale University)
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