移植后淋巴组织增生性疾病的临床病理分析

Clinicopathologic study of post-transplant lymphoproliferative disorders

目的探讨移植后淋巴组织增生性疾病（PTLD）的临床及病理特征，提高其诊断和治疗水平。方法对4例移植后淋巴组织增生性疾病行HE和免疫组织化学EnVision法染色、原位杂交及聚合酶链反应，复习其临床资料并随访。结果4例中3例是肾移植后，其中2例为多形性PTLD，1例为单形性PTLD；另1例是异体骨髓移植后PTLD的“早期”病变。2例EB病毒阳性。4例移植后所用免疫抑制剂均以环孢A类药为主，辅以激素。例1～4从移植到诊断PTLD的时间为42、7、129、2个月。例3多形性PTLD的临床分期为Ⅱ期（诊断PTLD后2个月死亡）；其余均为Ⅰ期。均存活，诊断PTLD后生存期为40（例1）、26（例2）、5（例4）个月。结论PTLD是发生在器官移植后，具有独特的形态和临床特征的淋巴组织增生性疾病，部分病例与EB病毒感染有关。其预后与临床分期相关，免疫抑制剂减量可能有效。

Objective To study the clinical and pathologic features of past-transplant lymphoproliferative disorders （PTLD）, and to investigate the clinical significance of this diagnosis. Methods Four cases of PTLD were studied by routine light microscopy, immunohistochemistry and in-situ hybridization and polymerase chain reaction. The clinical data and follow-up information were also reviewed. Results In the 4 cases, 3 cases occurred in renal transplant recipients and 1 in bone rnarrow transplant patient. In the 3 post-renal transplant patients, 2 had polymorphic PTLD and 1 had monomorphic PTLD. The post-bone rnarrow transplant case was classified as ＂early＂ lesion of PTLD. Epstein-Barr virus （EBV） was detected in 2 cases. All the 4 cases studied had received cyclosporine A and steroids after transplantation. The duration between organ transplantation and diagnosis of PTLD from case 1 to case 4 was 42,7,129,2 months. One of the polymorphic PTLD cases belonged to clinical stage Ⅱ and subsequently died of the disease. Other cases belonged to clinical stage I and were alive for 5 to 40 months after diagnosis of PTLD. Condusions PTLD is a lymphoproliferative disease with distinctive morphologic and clinical characteristics. An association with EBV at least in some cases is observed. The prognosis of PTLD correlates with clinical stage. It may respond to reduction in dosage of immunosuppressive agents.