ArticleJournal of hematopathology2026
Polymorphic EBV-positive post-transplant lymphoproliferative disorder of the colon mimicking EBV-positive mucocutaneous ulcer: a case report.
Article in Journal of hematopathology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundEpstein-Barr virus (EBV)-driven lymphoproliferative disorders (LPDs) are important complications of post-transplant immunosuppression. EBV-positive mucocutaneous ulcer (EBV-MCU) is typically a localized, solitary, sharply circumscribed ulcer with an indolent clinical course, whereas post-transplant lymphoproliferative disorder (PTLD) may be multifocal, disseminated, and life-threatening; however, these entities can overlap histologically on limited gastrointestinal biopsies. CASE PRESENTATION: We report a 60-year-old woman with autoimmune hepatitis/primary sclerosing cholangitis (PSC) status-post liver transplantation (2017; re-transplant 2019 for recurrent PSC) who presented with diarrheal illness and subsequently developed gastrointestinal bleeding. Imaging showed enterocolitis with periportal/mesenteric lymphadenopathy, and endoscopy demonstrated severe colitis with multiple superficial ulcers, without a mass lesion. Biopsies revealed severe active ileocolitis with ulceration and an atypical EBV-positive B cell proliferation (CD20/PAX5+, MUM1+, variably CD30+, EBV-LMP1+; polytypic light chains). The differential diagnosis included EBV-MCU and PTLD - although the superficial ulcerative pattern and absence of a mass initially raised consideration of EBV-MCU, the presence of multiple ulcers and lack of classic EBV-MCU histologic features favored EBV-positive polymorphic PTLD. MANAGEMENT AND
resultsLater, a PET-CT demonstrated extensive FDG-avid lymphadenopathy above and below the diaphragm with splenic and adrenal involvement, supporting disseminated EBV-positive PTLD and prompting rituximab-based chemotherapy.
conclusionThis case highlights the practical challenges of classifying EBV-positive ulcerative gastrointestinal lesions on small biopsies and underscores the need for radiologic and clinical correlation and close follow-up when EBV-MCU and PTLD are both plausible.
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