![A 40-year-old man, 4 years status after single-lung transplant on tacrolimus, presented with cervical lymphadenopathy. A lymph node biopsy showed a diffuse monotonous infiltrate of medium-sized lymphoid cells with regular nuclei, finely clumped chromatin, multiple small basophilic nucleoli, and squared-off cytoplasmic borders in a starry-sky background highly reminiscent of Burkitt lymphoma (BL) (panel A, 40× objective, original magnification ×400; hematoxylin and eosin stain). However, flow cytometry detected an abnormal immature T-cell population positive for CD34, cyCD3, CD2, CD5, CD7, and CD45 (panels B-E) but negative for CD10, terminal deoxynucleotidyl transferase, CD1a, and B-cell, myeloid (CD11c, CD13, CD33, and CD117) and other T-cell lineage–associated markers consistent with T lymphoblasts. Karyotype was abnormal: 46,XY,t(7;14)(p15;q32),del(9)(q21)[27]/46,XY[3]. Polymerase chain reaction analysis demonstrated a clonal T-cell receptor β gene rearrangement. T lymphoblasts involved <10% of the bone marrow and peripheral blood cellularity. All Epstein-Barr virus (EBV) study results were negative. Staging positron emission tomography/computed tomography scan showed a 5-cm anterior mediastinal mass. The clinicopathologic findings supported a monomorphic T-cell posttransplant lymphoproliferative disorder, T lymphoblastic lymphoma (T-LBL), EBV negative. The patient completed a hyper–cyclophosphamide, vincristine, doxorubicin, and dexamethasone chemotherapy regimen and is in remission.](https://ash.silverchair-cdn.com/ash/content_public/journal/blood/137/21/10.1182_blood.2021011188/1/m_bloodbld2021011188f1.png?Expires=1735814704&Signature=k2IB3wghu0hGOyBRp0Ov15fUxDLbukbQ0HhTtAlxN4EIieqGtnDA5X5PtwsQxiIlWA-~Evh8OYOIHCIqFeSRE~CgGarUdmWNM662207wAsZWsrBmQjTqrBQt8zpxXMVsXgj6LqoGRMZcBybmUzxpoLptOoKe9HdoL7J-2BgXXb667mMBbb3zlPOACsiKLz5TBnhvX-UQZy1pxZ~JP6uq~mWOphxw9VN3b1dF1VxzXc~f~5GaGO8X5gqgGTBjiCIn-79ujOGFU7GzywDMx1Zc8RmkYVKqTCDPslDh9O~YgxaQyiRXmN4NXGDKW2EmirHF1B9JZT1jj7RssDviiI4lDw__&Key-Pair-Id=APKAIE5G5CRDK6RD3PGA)
A 40-year-old man, 4 years status after single-lung transplant on tacrolimus, presented with cervical lymphadenopathy. A lymph node biopsy showed a diffuse monotonous infiltrate of medium-sized lymphoid cells with regular nuclei, finely clumped chromatin, multiple small basophilic nucleoli, and squared-off cytoplasmic borders in a starry-sky background highly reminiscent of Burkitt lymphoma (BL) (panel A, 40× objective, original magnification ×400; hematoxylin and eosin stain). However, flow cytometry detected an abnormal immature T-cell population positive for CD34, cyCD3, CD2, CD5, CD7, and CD45 (panels B-E) but negative for CD10, terminal deoxynucleotidyl transferase, CD1a, and B-cell, myeloid (CD11c, CD13, CD33, and CD117) and other T-cell lineage–associated markers consistent with T lymphoblasts. Karyotype was abnormal: 46,XY,t(7;14)(p15;q32),del(9)(q21)[27]/46,XY[3]. Polymerase chain reaction analysis demonstrated a clonal T-cell receptor β gene rearrangement. T lymphoblasts involved <10% of the bone marrow and peripheral blood cellularity. All Epstein-Barr virus (EBV) study results were negative. Staging positron emission tomography/computed tomography scan showed a 5-cm anterior mediastinal mass. The clinicopathologic findings supported a monomorphic T-cell posttransplant lymphoproliferative disorder, T lymphoblastic lymphoma (T-LBL), EBV negative. The patient completed a hyper–cyclophosphamide, vincristine, doxorubicin, and dexamethasone chemotherapy regimen and is in remission.
T-LBL after solid-organ transplant is particularly rare compared with BL. Furthermore, this case displayed histologic features highly suggestive of BL, a diagnostic pitfall, illustrating the importance of a multiparametric diagnostic approach.
A 40-year-old man, 4 years status after single-lung transplant on tacrolimus, presented with cervical lymphadenopathy. A lymph node biopsy showed a diffuse monotonous infiltrate of medium-sized lymphoid cells with regular nuclei, finely clumped chromatin, multiple small basophilic nucleoli, and squared-off cytoplasmic borders in a starry-sky background highly reminiscent of Burkitt lymphoma (BL) (panel A, 40× objective, original magnification ×400; hematoxylin and eosin stain). However, flow cytometry detected an abnormal immature T-cell population positive for CD34, cyCD3, CD2, CD5, CD7, and CD45 (panels B-E) but negative for CD10, terminal deoxynucleotidyl transferase, CD1a, and B-cell, myeloid (CD11c, CD13, CD33, and CD117) and other T-cell lineage–associated markers consistent with T lymphoblasts. Karyotype was abnormal: 46,XY,t(7;14)(p15;q32),del(9)(q21)[27]/46,XY[3]. Polymerase chain reaction analysis demonstrated a clonal T-cell receptor β gene rearrangement. T lymphoblasts involved <10% of the bone marrow and peripheral blood cellularity. All Epstein-Barr virus (EBV) study results were negative. Staging positron emission tomography/computed tomography scan showed a 5-cm anterior mediastinal mass. The clinicopathologic findings supported a monomorphic T-cell posttransplant lymphoproliferative disorder, T lymphoblastic lymphoma (T-LBL), EBV negative. The patient completed a hyper–cyclophosphamide, vincristine, doxorubicin, and dexamethasone chemotherapy regimen and is in remission.
T-LBL after solid-organ transplant is particularly rare compared with BL. Furthermore, this case displayed histologic features highly suggestive of BL, a diagnostic pitfall, illustrating the importance of a multiparametric diagnostic approach.
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![A 40-year-old man, 4 years status after single-lung transplant on tacrolimus, presented with cervical lymphadenopathy. A lymph node biopsy showed a diffuse monotonous infiltrate of medium-sized lymphoid cells with regular nuclei, finely clumped chromatin, multiple small basophilic nucleoli, and squared-off cytoplasmic borders in a starry-sky background highly reminiscent of Burkitt lymphoma (BL) (panel A, 40× objective, original magnification ×400; hematoxylin and eosin stain). However, flow cytometry detected an abnormal immature T-cell population positive for CD34, cyCD3, CD2, CD5, CD7, and CD45 (panels B-E) but negative for CD10, terminal deoxynucleotidyl transferase, CD1a, and B-cell, myeloid (CD11c, CD13, CD33, and CD117) and other T-cell lineage–associated markers consistent with T lymphoblasts. Karyotype was abnormal: 46,XY,t(7;14)(p15;q32),del(9)(q21)[27]/46,XY[3]. Polymerase chain reaction analysis demonstrated a clonal T-cell receptor β gene rearrangement. T lymphoblasts involved <10% of the bone marrow and peripheral blood cellularity. All Epstein-Barr virus (EBV) study results were negative. Staging positron emission tomography/computed tomography scan showed a 5-cm anterior mediastinal mass. The clinicopathologic findings supported a monomorphic T-cell posttransplant lymphoproliferative disorder, T lymphoblastic lymphoma (T-LBL), EBV negative. The patient completed a hyper–cyclophosphamide, vincristine, doxorubicin, and dexamethasone chemotherapy regimen and is in remission.](https://ash.silverchair-cdn.com/ash/content_public/journal/blood/137/21/10.1182_blood.2021011188/1/m_bloodbld2021011188f1.png?Expires=1735814705&Signature=nlDFD8sFYpk--6ou36OiiUvkhfgOGvaW~nYkOaMl0Wj5BzThWX-HJAvPC6rOGFPlO5vyoTY1M37~lMdxcrBfH2DHhp0QjAYI7uErLb9vPowxmJOGt13W8l43BkXv8jhzjjMefz1AnGVIIuPOOgVuhrPtVsnd-CJn6hZ6CtyogXDLf43yovpl884I22fz54Yi85Emyy~gBSmXaxqfdebk02TvaYzxdahTj1kFDILZjQrXY0G0hsSsiaW~turdqKzJ9cE~edpGBTXTzsIr2amuZKQTc-Be-x0nzwbRNxh45-7aEtOAf6w5lTYVJVvg0TxBNKXCcy124XVlg0VILWjpFw__&Key-Pair-Id=APKAIE5G5CRDK6RD3PGA)
