Late Epstein-Barr virus infection of a hepatosplenic gamma delta T-cell lymphoma arising in a kidney transplant recipient

Background and Objectives. gamma delta T-cell lymphomas am only exceptionally observed in transplanted patients. Aim of this study was the detailed characterization of one such case.

Design and Methods, The patient developed spontaneous splenic rupture six years after kidney transplantation. The splenic red pulp was Infiltrated by medium-sized and large lymphoid cells with two or more nucleoli, At autopsy, similar lymphoid cells Infiltrated the hepatic sinusoids, Histologic, immunologic and molecular studies were carried out.

Results. By immunohistochemistry, the atypical lymphoid cells were found to express CD3, CD45 and indicating their T-lineage origin. Approximately; 99% of spleen mononuclear cells (MNC) were CD3(+), gamma delta TcR+, CD4-, CDS, alpha beta TcR-. A clonal gamma delta TcR rearrangement (V gamma 1-J gamma 1.3/2.3-C gamma 2; V delta 1-D delta 2-J delta 1) was detected. The final diagnosis was peripheral T-cell lymphoma, hepato-splenic gamma delta-type. EBV infection of spleen MNC was documented by molecular studies However, in situ hybridization for EBER-1 (EBV-RNA) showed that only a minority of malignant lymphoid cells (5=7%) were EBV-infected,

Interpretation and conclusions, It is concluded that EBV Infection was as a late event involving an already transformed gamma delta T-cell clone,