An Autopsy Case of CD4-Positive Lymphoproliferative Disorder at 38 Years Post-Transplantation Presenting With Cardiac Invasion and Cerebral Infarctions

TL;DR

A rare case of T-cell lymphoma developed 38 years after a kidney transplant, leading to cardiac invasion and cerebral infarctions.

Contribution

Reports a rare long-term post-transplant T-cell lymphoma case with cardiac and cerebral complications.

Findings

T-cell lymphoma was identified as the cause of cerebral infarctions and systemic tumor dissemination.

The tumor was EBV-negative and classified as post-transplant lymphoproliferative disorder and peripheral T-cell lymphoma.

The case highlights the long-term risks of immunosuppression after organ transplantation.

Abstract

Lymphoma is a rare but life-threatening complication following solid organ transplantation. The vast majority of these lymphomas arise from B cells associated with Epstein-Barr virus (EBV), and a small number of cases have a T-cell origin. We here report a rare post-transplantation autopsy case of progressive T-cell lymphoma with cardiac invasion and extensive intravascular dissemination, which became evident at 38 years following kidney transplantation.

The patient was a 72-year-old male who had received a kidney transplantation at 34 years of age. He had a 16-year history of recurrent cutaneous squamous cell carcinomas with lymph node metastases. Following hospitalization, he experienced dysuria and pancytopenia and subsequently developed dysarthria. Radiological examination revealed bilateral multiple cerebral infarctions. Despite supportive treatment, he died on the 31st hospital day. The autopsy revealed T-cell lymphoma, primarily originating from the retroperitoneal lymph node with cardiac invasion, causing systemic dissemination of tumor cells to small arteries and capillaries. These circulating tumor cells, which were negative for EBV, may have induced tumor embolization and cerebral infarction. This case was classified as monomorphic T/NK-cell post-transplant lymphoproliferative disorder and peripheral T-cell lymphoma, not otherwise specified, in the fourth and fifth World Health Organization classifications, respectively. Further research is required to clarify the association between immunosuppression and lymphoproliferative disorders.

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