Posttransplantation lymphoproliferative disease involving the pituitary gland

Meriden, Zina; Bullock, Grant C.; Bagg, Adam; Bonatti, Hugo; Cousar, John B.; Lopes, M. Beatriz; Robbins, Mark K.; Cathro, Helen P.

doi:10.1016/j.humpath.2010.02.015

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Volume 41, Issue 11 , Pages 1641-1645, November 2010

Posttransplantation lymphoproliferative disease involving the pituitary gland☆

Zina Meriden, MD
- Department of Pathology, University of Virginia Health System, PO Box 800214, Charlottesville, VA 22908, USA
Grant C. Bullock, MD, PhD
- Department of Pathology, University of Virginia Health System, PO Box 800214, Charlottesville, VA 22908, USA
Adam Bagg, MD
- Department of Pathology and Laboratory Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA 19104, USA
Hugo Bonatti, MD
- Department of Surgery, University of Virginia Health System, Charlottesville, VA 22908, USA
John B. Cousar, MD
- Department of Pathology, University of Virginia Health System, PO Box 800214, Charlottesville, VA 22908, USA
M. Beatriz Lopes, MD, PhD
- Department of Pathology, University of Virginia Health System, PO Box 800214, Charlottesville, VA 22908, USA
Mark K. Robbins, MD
- Department of Internal Medicine, University of Virginia Health System, Charlottesville, VA 22908, USA
Helen P. Cathro, MBChB
- Department of Pathology, University of Virginia Health System, PO Box 800214, Charlottesville, VA 22908, USA
- Corresponding author.

Received 27 October 2009; received in revised form 29 January 2010; accepted 9 February 2010. published online 26 July 2010.

Summary

Posttransplantation lymphoproliferative disorders (PTLD) are heterogeneous lesions with variable morphology, immunophenotype, and molecular characteristics. Multiple distinct primary lesions can occur in PTLD, rarely with both B-cell and T-cell characteristics. Lesions can involve both grafted organs and other sites; however, PTLD involving the pituitary gland has not been previously reported. We describe a patient who developed Epstein-Barr virus–negative PTLD 13 years posttransplantation involving the terminal ileum and pituitary, which was simultaneously involved by a pituitary adenoma. Immunohistochemistry of the pituitary lesion showed expression of CD79a, CD3, and CD7 with clonal rearrangements of both T-cell receptor gamma chain (TRG@) and immunoglobulin heavy chain (IGH@) genes. The terminal ileal lesion was immunophenotypically and molecularly distinct. This is the first report of pituitary PTLD and illustrates the potentially complex nature of PTLD.

Keywords: Posttransplantation lymphoproliferative disorder, T-cell lymphoma, B-cell lymphoma, EBV-negative, Pituitary