The American Journal of Surgical Pathology
ORIGINAL ARTICLES
Posttransplantation Plasmacytic Proliferations Related to Kaposi's Sarcoma–Associated Herpesvirus
Matsushima, Anne Y. M.D.; Strauchen, James A. M.D.; Lee, Grace M.D.; Scigliano, Eileen M.D.; Hale, Evelyn E. B.A.; Weisse, Marie T. B.S.; Burstein, David M.D.; Kamel, Onsi M.D.; Moore, Patrick S. M.D., M.PH.; Chang, Yuan M.D.
From the Department of Pathology (A.Y.M., E.E.H., M.T.W., P.S.M., Y.C.), Columbia University College of Physicians and Surgeons, New York, New York; the Departments of Pathology (J.A.S., G.L., D.B.) and Medicine (E.S.), Mount Sinai School of Medicine, New York, New York; and the Department of Pathology (O.K.), St. John's Hospital, Springfield, Illinois, U.S.A.
Address correspondence and reprint requests to Dr. Yuan Chang, Department of Pathology, Columbia University College of Physicians and Surgeons, 630 West 168th Street, New York, NY 10032, U.S.A.
This work was supported by NIH grants CA68939 and CA76586.
Abstract
Kaposi's sarcoma–associated herpesvirus (KSHV), which was originally detected in Kaposi's sarcoma, also has been found in primary effusion lymphomas (PELs) and some cases of multicentric Castleman's disease. We describe two transplant recipients who developed Kaposi's sarcoma and a spectrum of nonneoplastic lymphoproliferative disorders that show pronounced plasmacytic and plasmacytoid features. The first patient had recurrent pleural effusions and Castleman's disease–like changes in lymph nodes. The second patient had systemic lymphadenopathy and hepatosplenomegaly secondary to diffuse infiltration by polyclonal plasma cells and plasmacytoid B lymphocytes that clinically mimicked Epstein-Barr virus (EBV)–associated posttransplant lymphoproliferative disease. In both cases, KSHV DNA was detected by polymerase chain reaction and Southern blotting, and KSHV vIL-6 protein expression was identified in affected tissues by immunohistochemical localization. In contrast, no evidence of KSHV coinfection was detected in any of 31 EBV-related posttransplant lymphoproliferative disorders or 112 non-PEL lymphomas tested. The pathologic findings in these two patients were not representative of malignancy by morphologic, immunophenotypic, or molecular criteria. This study underscores the marked propensity for hematolymphoid proliferations associated with KSHV infections to show plasmacytic features. Additionally, this study describes use of an antibody reactive against KSHV vIL-6 that can readily detect a subpopulation of KSHV-infected hematopoietic cells.