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Plasmacytoma-Like Post-Transplantation Lymphoproliferative Disease Occurring in a Cardiac Allograft: A Case Report and Review of the Literature

Year: 2012

Type: article

Abstract: and Review of the Literature Case ReportA 33-year-old woman with a history of an orthotopic heart transplantation in 2006 for a left anterior descending artery dissection presented 5 years post-transplantation with intermittent palpitations and light headedness for 2 months.The patient had multiple episodes of acute and chronic rejection since her transplantation, and her immunosuppression consisted of prednisone 5 mg per day, mycophenolate mofetil, tacrolimus, and rapamune at the time of presentation.Telemetry monitoring revealed a new onset of sinus pauses.An echocardiogram showed normal biventricular function with left ventricular hypertrophy and biatrial enlargement.Myocardial magnetic resonance imaging of the heart demonstrated patchy areas of delayed contrast enhancement that mostly involved the left ventricular infe-rior and lateral wall (Fig 1A, arrow), foci within the inferior septum (Fig 1B, arrow), and the right ventricular free wall and apex, which indicated a pattern not typical of ischemic disease and most compatible with an infiltrative process.An endomyocardial biopsy revealed sheets of plasma cells (Figs 2A and 2B; hematoxylin and eosin stain; original magnifications: A, ϫ20; B, ϫ100) that were CD138ϩ (Fig 2C; immunohistochemical stain for CD138; original magnification ϫ40) and light chain restricted (Fig 2D; in situ hybridization stain for kappa light chains; original magnification ϫ20), with only occasional lightchain positivity (Fig 2E; in situ hybridization stain for lambda light chains; original magnification ϫ20).Epstein-Barr virus (EBV) -encoded RNA in situ hybridization stain was negative (Fig 2F; original magnification ϫ40).Diffuse lymphocytic infiltrates of the myocardium were found in the background, which were consistent with grade 1R cellular rejection according to the International Society for Heart and Lung Transplantation criteria.1 This presentation was consistent with plasmacytoma-like monomorphic B-cell posttransplantation lymphoproliferative disease (PTLD) occurring in the setting of graft rejection.

Source: Journal of Clinical Oncology

DOI: 10.1200/jco.2011.39.5855