An Unusual Case of Peripheral T-Cell Lymphoma With Dual T-Cell Receptor Expression in a Posttransplant Patient. (11th September 2019)

• Record Type: Journal Article
• Authors: Liu, Shujuan; Olsen, Randall; Thrall, Michael; Ewton, April; Miller, Tara; Zieske, Arthur; Zu, Youli; Hao, Suyang
• Is Part Of: American journal of clinical pathology. Volume 152(2019)Supplement 1
• Page Start: S112
• Page End: S113
• Publication Date: 2019-09-11
• Subjects: Diagnosis, Laboratory -- Periodicals; Pathology -- Periodicals; 616.07
• DOI: 10.1093/ajcp/aqz121.020
• Languages: English
• ISSNs: 0002-9173

Abstract

Abstract: Objective: Three main patterns of T-cell receptor (TCR) expression are identified in T-cell lymphomas (TCLs): common TCR-AB type, TCR-GD type, and TCR silent type in which no expression of either AB or GD TCR is detected. Cases of TCL that express both AB and GD receptors are very rare. We present a case of peripheral TCL with dual TCR expression in a posttransplant patient. Case Presentation: A 61-year-old female with a medical history of AL amyloidosis-induced chronic heart failure received a cardiac transplant in 2012 and an autologous stem cell transplantation in 2013. A chest CT performed in 2018 due to fatigue, fever, worsening anemia, and thrombocytopenia showed multiple irregular lung nodules and diffuse lymphadenopathy. Endobronchial ultrasound-guided fine-needle aspiration of the lymph nodes was performed. The cytology evaluation revealed large atypical neoplastic cells with round or irregular nucleus with hyperchromatic chromatin. Immunohistochemical study showed the neoplastic cells positive for CD3, CD8, TIA1, CD56, CD57, and granzyme B and negative for CD5, CD4, and CD30. Epstein-Barr virus (EBV) was negative by EBER in situ hybridization study. The corresponding flow cytometry demonstrated T cells with both TCR-GD and TCR-AB expression and loss of CD5. TCR gene rearrangement studies revealed the presence of a clonal lymphoid population with TCRB and TCRG rearrangement. A diagnosis of peripheral T-cell lymphoma, NOS was made. Given the patient's history of heart transplantation, the findings might represent an EBV-negative TCL in posttransplant lymphoproliferative disorders (PTLDs). Results: With no response to decreased immunosuppression and chemotherapy, the patient died shortly after the diagnosis. Conclusion: We report an aggressive TCL with dual TCR expression with no overt direct attribution to EBV infection in a posttransplant patient. The clinical significance and the biology of such cases are not reported in current literature and warranted for further investigation.