EBV+ Polymorphous Post Transplant Lymphoproliferative Disorder

Lessons From the Friday Unknowns

The patient is a 41-year-old female with common variable immunodeficiency (CVID) (agammaglobulinemia).

Histologic sections show core biopsies with a polymorphous infiltrate composed of predominantly small, mature-appearing lymphocytes with scattered admixed larger lymphoid cells (somewhat resembling Hodgkin cells) and histiocytes.

Mild focal sclerosis can be appreciated in the background. There is no increase in plasma cells or eosinophils in the background. No increased mitotic activity, apoptosis or necrosis seen.

Immunohistochemical stains show that the larger atypical lymphoid cells express CD20 (strong), PAX5, CD30, CD45, BCL6 (subset), MUM-1; they do not express CD10, CD15 or PD-1. Ki-67 stain…