Epstein–Barr Virus-Associated Anaplastic Large Cell Lymphoma in Renal Transplant Patients

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Abstract
A novel association, Epstein–Barr virus-positive Ki-1 +/CD30+ anaplastic large cell non-Hodgkin’s lymphoma of B-cell phenotype in immunosuppressed renal transplant recipients is reported. Case 1 involved an aggressive clinical evolution, whereas case 2 followed a more ”benign” clinical course. Both lymphomas were Epstein–Barr virus-positive as assessed by in situ hybridization, Southern blot, polymerase chain reaction, and immunohistochemical analysis. Both lymphomas contained a single clonal Epstein–Barr virus terminal-repeat fragment. In case 1, clonality was confirmed by the detection of biallelic immunoglobulin (Ig) heavy chain gene rearrangement. Case 2 showed germline Ig genes at presentation and oligoclonal Ig heavy chain gene rearrangements at relapse. These results are consistent with the notion that anaplastic large cell lymphoma might arise in a B cell transformed by Epstein–Barr virus at a very early stage, before Ig gene rearrangement. The latter may occur later in the course of clonal evolution, thus permitting investigators to trace intermediate and late stages within a process of multistep lymphomagenesis and/or tumor progression.

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