Original Works: Case ReportsLiverAn Unusual Posttransplant T-cell Lymphoma After Liver Transplantation: A Case Report

•T-cell post-transplant lymphoproliferative disorders (PTLDs) are an uncommon complication of solid organ transplantation, and they are usually aggressive with a poor outcome.•A 57-year-old man with graft-versus-host disease after liver transplantation developed generalized lymphadenopathy, which was discovered to be an Epstein-Barr virus-negative monomorphic T-cell PTLD according to biopsy results. The diagnosis was made after consultation with 2 different institutions. The entity was difficult to classify due to its unusual morphology and early presentation.•Unlike most Epstein-Barr virus-negative PTLDs, this T-cell lymphoma responded completely to therapy, and the patient is currently in remission 4 years after treatment.•Patients who develop generalized lymphadenopathy after solid organ transplantation should be followed up closely because they are at an increased risk of neoplastic transformations.

Posttransplantation lymphoproliferative disorders (PTLDs) encompass a spectrum of heterogeneous entities ranging from benign lymphocytic proliferations to high-grade malignant lymphomas. The majority of PTLDs are associated with reactivation of Epstein-Barr virus (EBV), which induces B-cell proliferation and occurs in the setting of severe immune suppression after solid organ or bone marrow transplantation. T-cell/natural killer cell PTLDs are relatively rare, constituting ∼15% of all cases. T-cell PTLDs are usually aggressive, and outcomes are poor. This article describes an unusual case of T-cell PTLD with a favorable outcome. The patient is a 57-year-old man who underwent a liver transplantation due to hepatitis C cirrhosis. He developed graft-versus-host disease with skin and gastrointestinal involvement and generalized lymphadenopathy 4 months after transplantation. Histologic sections of an excised axillary lymph node showed atypical medium and larger T-lymphocytes that were positive for CD3, CD5, CD43, and CD8 but were negative for B-cell antigens, CD56, and in situ hybridization for EBV-encoded RNA. Polymerase chain reaction analysis revealed monoclonal T-cell receptor gamma chain gene rearrangement. A diagnosis of high-grade T-cell PTLD was made. The patient was treated with 4 cycles of cyclophosphamide, doxorubicin, vincristine, and prednisone and is currently in remission, 4 years after therapy. The rapid presentation of an EBV-negative T-cell PTLD with a nonaggressive course and complete response to treatment is an unusual presentation of posttransplantation T-cell lymphoma, which is usually associated with a high mortality rate.