¹Department of Pathology, Columbia University, New York, NY, USA

Correspondence: B Alobeid, Department of Pathology, Hematopathology Division, 14-229 Vanderbilt Clinic, 630 West 168th Street, College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA. E-mail: ba2024@columbia.edu

Received 8 July 2002; Revised 20 October 2003; Accepted 21 October 2003; Published online 19 November 2003.

Abstract

Post-transplantation lymphoproliferative disorders (PTLDs) are predominantly Epstein–Barr virus (EBV)-associated B-cell lymphoproliferations. PTLDs of T-cell lineage are rare, mostly reported after renal transplantation and show less frequent association with EBV. NK-cell lymphomas after transplantation (NK-cell PTLDs) are very rare; only five cases are reported so far in the English literature, all developed after renal transplantation. We describe a case of EBV-associated, extranodal NK-cell lymphoma of nasal type, involving the breast in a cardiac allograft recipient 5 years after transplantation. The neoplastic cells are positive for CD2, cytoplasmic CD3, CD7, CD43, CD56, TIA-1 and p53; and negative for surface CD3 and CD57. Analysis of T-cell receptor beta and gamma genes fails to show clonal rearrangement. EBV studies show clonal episomal integration of EBV and latency II pattern (EBER-1+, LMP-1+, EBNA-1+, EBNA-2-). In conclusion, NK-cell PTLDs are rare complications that arise relatively late after solid organ transplantation, show strong association with EBV, and can follow an aggressive clinical course. To the best of our knowledge, we present the first reported case of NK-cell PTLD after cardiac transplantation and the unifying clinical and diagnostic features of NK-cell PTLDs occurring after solid organ transplantation.