Neoplasia: post-transplant lymphoproliferative disorder: practice question

A Pathology question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Pathology · Neoplasia: post-transplant lymphoproliferative disorder

Sample item

A 30-year-old renal transplant recipient on tacrolimus and mycophenolate develops cervical lymphadenopathy 8 months after transplantation. Node biopsy shows a polymorphous proliferation of B cells that stain for EBV-encoded RNA. Which mechanism best explains the disorder?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

B. Loss of T-cell control over EBV-infected B cells

Post-transplant lymphoproliferative disorder results from impaired cytotoxic T-cell surveillance during immunosuppression, which allows EBV-infected B cells to proliferate. Early lesions may regress when immunosuppression is reduced. Lesions range from polymorphous hyperplasia to monomorphic lymphoma.

Option by option

  • A. Donor T cells attacking recipient lymphoid tissue

    Donor T cells attacking recipient tissue is graft-versus-host disease, seen mainly after marrow transplantation.

  • B. Loss of T-cell control over EBV-infected B cells (correct)

    Correct. Failure of T-cell surveillance lets EBV-driven B-cell proliferation expand.

  • C. Reactivation of HHV-8 in lymph node endothelium

    HHV-8 reactivation is linked to Kaposi sarcoma, and the EBV-encoded RNA here points to EBV.

  • D. Direct mutagenic effect of tacrolimus on B-cell DNA

    Calcineurin inhibitors act by blocking T-cell signalling and are not the direct mutagen in this disorder.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this Pathology question

What is the answer to this Pathology question?

The best answer is B, Loss of T-cell control over EBV-infected B cells. Post-transplant lymphoproliferative disorder results from impaired cytotoxic T-cell surveillance during immunosuppression, which allows EBV-infected B cells to proliferate.

Why is "Donor T cells attacking recipient lymphoid tissue" not the answer?

Donor T cells attacking recipient tissue is graft-versus-host disease, seen mainly after marrow transplantation.

Why is "Reactivation of HHV-8 in lymph node endothelium" not the answer?

HHV-8 reactivation is linked to Kaposi sarcoma, and the EBV-encoded RNA here points to EBV.

Why is "Direct mutagenic effect of tacrolimus on B-cell DNA" not the answer?

Calcineurin inhibitors act by blocking T-cell signalling and are not the direct mutagen in this disorder.

What concept does this question test?

It tests Neoplasia: post-transplant lymphoproliferative disorder in Pathology. Early lesions may regress when immunosuppression is reduced. Lesions range from polymorphous hyperplasia to monomorphic lymphoma.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Neoplasia: post-transplant lymphoproliferative disorder?

Learn each disease as a bundle: cause, key histology, markers, and the clinical hallmark. Then use the flashcards and the other Pathology questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.