Figure 537

Malignant lymphoma in the transplanted kidney. A 55-year-old man with end-stage renal disease due to diabetic nephropathy received a cadaveric renal transplant. He was managed with pred-nisone, azathioprine, and antilymphocyte globulin (ALG). The allo-graft functioned poorly despite therapy a week later with OKT3. Results of a percutaneous renal biopsy were suspicious for a lym-phoproliferative disorder in the renal allograft. He had a transplant nephrectomy 5 weeks after the original surgery. Pathologic study of the allograft showed extensive infiltration of the interstitium, renal pelvis, and blood vessels with large round and ovoid lymphocytes with many nucleoli and scant cytoplasm, diagnostic of a malignant lymphoma. Special studies revealed the lymphoid cells to be poly-clonal in nature, and the patient's serologic testing was positive for Epstein-Barr virus. Immunosuppression was stopped, and therapy with ganciclovir was started.

0 0

Post a comment