Double-hit monomorphic B-cell lymphoma after liver transplantation.
Zabreen TahirJulia PetersKathleen LeahyFelipe BataliniPublished in: BMJ case reports (2020)
We report the first case of double-hit (MYC and BCL-6) monomorphic post-transplant lymphoproliferative disorder in a patient status post liver transplantation. Our patient is a 71-year-old man with a past medical history of Budd-Chiari syndrome complicated by cirrhosis and hepatocellular carcinoma. He underwent a deceased donor liver transplantation 2 years prior to presentation and was maintained on tacrolimus and mycophenolate mofetil for immunosuppression. He presented with a 3-week history of classical B-symptoms. Initial workup was notable for elevated lactate dehydrogenase. Abdomen ultrasound revealed multiple hypoechoic lesions, raising suspicion for a post-transplant lymphoproliferative disorder. Biopsy showed pleomorphic large neoplastic cells throughout, consistent with a diagnosis of diffuse large B-cell lymphoma. Cytogenetics then revealed rearrangements in both MYC and BCL-6, consistent with double-hit lymphoma. His immunosuppressive regimen was subsequently tapered and he was started on DA-EPOCH-R (dose-adjusted etoposide, prednisone, vincristine, cyclophosphamide, doxorubicin and rituximab) regimen.
Keyphrases
- diffuse large b cell lymphoma
- epstein barr virus
- case report
- induced apoptosis
- single cell
- magnetic resonance imaging
- transcription factor
- healthcare
- low dose
- cell cycle arrest
- ultrasound guided
- inferior vena cava
- drug delivery
- clinical trial
- oxidative stress
- signaling pathway
- randomized controlled trial
- cell death
- depressive symptoms
- endoplasmic reticulum stress