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Case Reports in Hematology
Volume 2013, Article ID 386147, 7 pages
http://dx.doi.org/10.1155/2013/386147
Case Report

A Unique “Composite” PTLD with Diffuse Large B-Cell and T/Anaplastic Large Cell Lymphoma Components Occurring 17 Years after Transplant

1Department of Pathology, University of Virginia School of Medicine, Charlottesville, VA 22908, USA
2University of New Mexico School of Medicine, Albuqurque, NM 87131, USA
3Department of Medicine, University of Chicago, Pritzker School of Medicine, Chicago, IL 60637, USA
4Department of Pathology and Laboratory Medicine, University of Wisconsin School of Medicine and Public Health, K4/432 Clinical Science Center, 600 Highland Avenue, Madison, WI 53792, USA

Received 18 March 2013; Accepted 10 April 2013

Academic Editors: E. Bissé, M. Gentile, M. Nagasawa, and N. Nara

Copyright © 2013 Kristin La Fortune et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Posttransplant lymphoproliferative disorder (PTLD) comprises a spectrum ranging from polyclonal hyperplasia to aggressive monoclonal lymphomas. The majority of PTLDs are of B-cell origin while T-cell PTLDs and Hodgkin lymphoma-like PTLDs are uncommon. Here, we report a unique case of a 56-year-old man in whom a lymphoma with two distinct components developed as a duodenal mass seventeen years following a combined kidney-pancreas transplant. This PTLD, which has features not previously reported in the literature, consisted of one component of CD20 positive and EBV negative monomorphic diffuse large B-cell lymphoma. The other component showed anaplastic morphology, expressed some but not all T-cell markers, failed to express most B-cell markers except for PAX5, and was diffusely EBV positive. Possible etiologies for this peculiar constellation of findings are discussed and the literature reviewed for “composite-like” lymphomas late in the posttransplant setting.