{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,13]],"date-time":"2026-06-13T11:56:01Z","timestamp":1781351761156,"version":"3.54.1"},"reference-count":11,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,6,13]],"date-time":"2026-06-13T00:00:00Z","timestamp":1781308800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,6,13]],"date-time":"2026-06-13T00:00:00Z","timestamp":1781308800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["J Hematopathol"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Epstein-Barr virus (EBV)\u2013driven 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case Presentation<\/jats:title>\n                    <jats:p>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 -\u00a0 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Management and Results<\/jats:title>\n                    <jats:p>Later, 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This 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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s12308-026-00712-7","type":"journal-article","created":{"date-parts":[[2026,6,13]],"date-time":"2026-06-13T11:05:18Z","timestamp":1781348718000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Polymorphic EBV-positive post-transplant lymphoproliferative disorder of the colon mimicking EBV-positive mucocutaneous ulcer: a case report"],"prefix":"10.1007","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-9438-2881","authenticated-orcid":false,"given":"McKenzie","family":"Wallace","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alicia","family":"Dessain","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Soumya","family":"Mikkilineni","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard D.","family":"Hammer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,6,13]]},"reference":[{"issue":"15","key":"712_CR1","doi-asserted-by":"publisher","first-page":"3815","DOI":"10.3390\/cancers13153815","volume":"13","author":"E Ishikawa","year":"2021","unstructured":"Ishikawa E, Satou A, Nakamura M, Nakamura S, Fujishiro M (2021) Epstein-Barr virus positive B-cell lymphoproliferative disorder of the gastrointestinal tract. Cancers (Basel) 13(15):3815.https:\/\/doi.org\/10.3390\/cancers13153815","journal-title":"Cancers (Basel)"},{"issue":"1","key":"712_CR2","doi-asserted-by":"publisher","first-page":"13","DOI":"10.1186\/s40164-016-0042-5","volume":"5","author":"TK Roberts","year":"2015","unstructured":"Roberts TK, Chen X, Liao JJ (2015) Diagnostic and therapeutic challenges of EBV-positive mucocutaneous ulcer: a case report and systematic review of the literature. Exp Hematol Oncol 5:13.https:\/\/doi.org\/10.1186\/s40164-016-0042-5","journal-title":"Exp Hematol Oncol"},{"key":"712_CR3","unstructured":"Singh AP, Gru AA. EBV+ mucocutaneous ulcer. PathologyOutlines.com website. https:\/\/www.pathologyoutlines.com\/topic\/lymphomaebvmucocutulcer.html. Accessed 5 Aug 2025"},{"issue":"11","key":"712_CR4","doi-asserted-by":"publisher","first-page":"1229","DOI":"10.1182\/blood.2022015851","volume":"140","author":"E Campo","year":"2022","unstructured":"Campo E, Jaffe ES, Cook JR, Quintanilla-Martinez L, Swerdlow SH, Anderson KC et al (2022) The International Consensus Classification of Mature Lymphoid Neoplasms: a report from the Clinical Advisory Committee. Blood 140(11):1229\u20131253. https:\/\/doi.org\/10.1182\/blood.2022015851","journal-title":"Blood"},{"issue":"3","key":"712_CR5","doi-asserted-by":"publisher","first-page":"405","DOI":"10.1097\/PAS.0b013e3181cf8622","volume":"34","author":"SD Dojcinov","year":"2010","unstructured":"Dojcinov SD, Venkataraman G, Raffeld M, Pittaluga S, Jaffe ES (2010) EBV positive mucocutaneous ulcer-a study of 26 cases associated with various sources of immunosuppression. Am J Surg Pathol 34(3):405\u2013417. https:\/\/doi.org\/10.1097\/PAS.0b013e3181cf8622","journal-title":"Am J Surg Pathol"},{"key":"712_CR6","unstructured":"WHO Classification of Tumours Editorial Board (2024) Haematolymphoid Tumours, 5th ed. International Agency for Research on Cancer, Lyon. WHO Classification of Tumours series, vol 11"},{"issue":"8","key":"712_CR7","doi-asserted-by":"publisher","first-page":"268","DOI":"10.5500\/wjt.v12.i8.268","volume":"12","author":"W Reiche","year":"2022","unstructured":"Reiche W, Tauseef A, Sabri A, Mirza M, Cantu D, Silberstein P, Chandan S (2022) Gastrointestinal manifestations, risk factors, and management in patients with post-transplant lymphoproliferative disorder: a systematic review. World J Transplant 12(8):268\u2013280. https:\/\/doi.org\/10.5500\/wjt.v12.i8.268","journal-title":"World J Transplant"},{"key":"712_CR8","unstructured":"Cassidy D, Chapman J. PTLD-polymorphic. PathologyOutlines.com website. https:\/\/www.pathologyoutlines.com\/topic\/lymphomanonbpolymorphicb.html. Accessed 5 Aug 2025"},{"issue":"9","key":"712_CR9","doi-asserted-by":"publisher","DOI":"10.1097\/TXD.0000000000001510","volume":"9","author":"J Fallon","year":"2023","unstructured":"Fallon J, Rendek A, Harden P, Udupa V (2023) Donor-derived Epstein-Barr virus mucocutaneous ulceration: a unique and complex case of rectal hemorrhage. Transplant Direct 9(9):e1510. https:\/\/doi.org\/10.1097\/TXD.0000000000001510","journal-title":"Transplant Direct"},{"issue":"1057","key":"712_CR10","doi-asserted-by":"publisher","first-page":"20150844","DOI":"10.1259\/bjr.20150844","volume":"89","author":"U Metser","year":"1057","unstructured":"Metser U, Lo G (1057) FDG-PET\/CT in abdominal post-transplant lymphoproliferative disease. Br J Radiol 89(1057):20150844. https:\/\/doi.org\/10.1259\/bjr.20150844","journal-title":"Br J Radiol"},{"issue":"2","key":"712_CR11","doi-asserted-by":"publisher","first-page":"1323","DOI":"10.21037\/qims-23-1059","volume":"14","author":"C Wang","year":"2024","unstructured":"Wang C, Wang G, Wang W, Kan Y, Zhang M, Yang J (2024) The role of 18F-FDG PET\/CT metabolic parameters in the differential diagnosis of post-transplant lymphoproliferative disorder after pediatric liver transplantation. Quant Imaging Med Surg 14(2):1323\u20131334. https:\/\/doi.org\/10.21037\/qims-23-1059","journal-title":"Quant Imaging Med Surg"}],"container-title":["Journal of Hematopathology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s12308-026-00712-7.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s12308-026-00712-7","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s12308-026-00712-7.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,13]],"date-time":"2026-06-13T11:05:21Z","timestamp":1781348721000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s12308-026-00712-7"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,13]]},"references-count":11,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["712"],"URL":"https:\/\/doi.org\/10.1007\/s12308-026-00712-7","relation":{},"ISSN":["1865-5785"],"issn-type":[{"value":"1865-5785","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,13]]},"assertion":[{"value":"7 January 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"7 June 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"13 June 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"This study was performed in accordance with institutional policy. Ethical approval was not required as this was a single case report using de-identified data.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}},{"value":"Consent for treatment and use of de-identified clinical information for research was obtained or waived in accordance with institutional policy.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Informed consent"}},{"value":"Consent for publication was obtained or waived in accordance with institutional policy.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare no competing interests.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}}],"article-number":"33"}}