1. Posttransplant Lymphoproliferative Disorder Following Kidney Transplant 
Alicia K. Morgans, MD, Ran Reshef, MD, Donald E. Tsai, MD, PhD 
American Journal of Kidney Diseases 
Volume 55, Issue 1, Pages (January 2010)
DOI: /j.ajkd
Copyright © 2009 National Kidney Foundation, Inc. Terms and Conditions

2. Figure 1
(A-C) Photomicrographs of monomorphic posttransplant lymphoproliferative disorder (PTLD) in a 54-year-old man show typical staining patterns. (A) Hematoxylin and eosin stain shows sheets of large atypical cells. (B) CD20 immunohistochemistry shows numerous cells with surface membrane staining, indicating a B-cell lesion. (C) In situ hybridization identifies Epstein-Barr virus (EBV)-encoded RNA (EBER; also known as EBV latency-associated RNA) expression in most cells. This staining pattern is nuclear and identifies EBV-infected cells. (D) Hodgkin-like PTLD shows large binucleate cells (Reed-Sternberg cells) scattered within an inflammatory infiltrate. (E) Polymorphic PTLD shows different phases of B-cell maturation with cellular atypia and distortion of the normal lymphoid architecture. (Courtesy of Dr Dale Frank).
American Journal of Kidney Diseases  , DOI: ( /j.ajkd )
Copyright © 2009 National Kidney Foundation, Inc. Terms and Conditions

3. Figure 2
A suggested algorithm for the diagnosis and treatment of posttransplant lymphoproliferative disorder (PTLD). Clinical presentation is highly variable and all patients should undergo a diagnostic biopsy, imaging, and laboratory tests for staging and prognostication (see Box 2 for more details). Patients with 0-1 poor prognostic features and no signs of rejection can be treated with reduction of immunosuppression initially. Other patients should be treated with rituximab and/or cytotoxic chemotherapy according to their disease features. Selected cases can be treated with surgery or radiotherapy, either alone or in combination with other modalities. Abbreviations: CNS, central nervous system; CT, computed tomography; EBV, Epstein-Barr virus; LDH, lactate dehydrogenase; PCR, polymerase chain reaction; PET, positron emission tomography; XRT, radiotherapy. Adapted and reproduced from Tsai et al52 with kind permission of Springer Science and Business Media.
American Journal of Kidney Diseases  , DOI: ( /j.ajkd )
Copyright © 2009 National Kidney Foundation, Inc. Terms and Conditions