Incisional and excisional biopsy

Histologically, the specimen was made up of a dense, diffuse infiltrate of B-lymphocytes with plasmacytoid differentiation.  There was evidence of high mitotic activity and focal necrosis.  The Immunohistochemistry studies confirmed that the cells were monoclonal for lambda light chain, uniformly positive for CD138, negative for CD20 and CD45 and strongly positive (70% of the infiltrate) for Epstein-Barr virus. The H & E histology and the immunocytochemistry findings are consistent with a post transplant lymphoproliferative disorder, “plasmacytoma-like” type by the WHO classification system.

Figure 2. Low power (x100) This represents the H & E histology which shows sheets of monoclonal B-lymphocytes with plasma-cell morphology.  There is evidence of necrosis and high-mitotic activity.  The histology is consistent with post-transplant lymphoproliferative disorder “plasmacytoid-like”.

 

Figure 3. Higher power (x200) This represents the immunohistochemistry staining with antibody to lambda light chain demonstrating uniformly positive tumor cells.

 

Figure 4. Higher power (x200) This represents the immunohistochemistry staining with antibody to CD138 demonstrating uniformly positive tumor cells.

Figure 5. Higher power (x200) This represents the immunohistochemistry staining with antibody to Epstein Barr virus demonstrating uniformly positive tumor cells.