The effectiveness of tonsillectomy in diagnosing lymphoproliferative disease in pediatric patients after liver transplantation.
OBJECTIVE
To determine the effectiveness of diagnosing forms of lymphoproliferative disease by performing tonsillectomy in pediatric patients who develop symptomatic or asymptomatic tonsillar hypertrophy during immunosuppressive therapy after liver transplantation.


METHODS
Retrospective chart and pathological review.


METHODS
Urban tertiary referral children's hospital.


METHODS
The presence of a pathological stage of lymphoproliferative disease or Epstein-Barr virus (EBV) diagnosed using tonsillar specimens, resulting in a change in therapy.


RESULTS
Of 275 pediatric patients who underwent liver transplantation, 13 had tonsillectomy performed with histopathological review of the tonsillar specimens. The specimens from 5 patients (39%) demonstrated pathological changes thought to be consistent with EBV-related changes or a form of lymphoproliferative disease. Histological changes ranged from tonsillar hyperplasia associated with EBV infection to large cell lymphoma. Immunosuppressive therapy was reduced or discontinued, and antiviral therapy was initiated.


CONCLUSIONS
Children who have undergone liver transplantation and develop tonsillar hypertrophy should undergo a diagnostic tonsillectomy, regardless of the clinical presentation, to rule out a form of posttransplant lymphoproliferative disease. Arch Otolaryngol Head Neck Surg. 2000;126:1444-1447
Broughton
S
S
Department of Otolaryngology-Head and Neck Surgery, University of Texas at Southwestern, 5323 Harry Hines Blvd, Dallas, TX 75235, USA.
McClay
J E
JE
Murray
A
A
Timmons
C
C
Sommerauer
J
J
Andrews
W
W
Harkins
P
P
D000998:Antiviral Agents / Q000627:therapeutic use; D002648:Child; D020031:Epstein-Barr Virus Infections / Q000175:diagnosis* / Q000188:drug therapy; D005500:Follow-Up Studies; D004854:Herpesvirus 4, Human / Q000235:genetics / Q000302:isolation & purification; D006801:Humans; D006965:Hyperplasia; D006984:Hypertrophy; D007165:Immunosuppression Therapy; D017403:In Situ Hybridization; D007580:Jejunal Neoplasms / Q000175:diagnosis / Q000473:pathology; D016031:Liver Transplantation; D016403:Lymphoma, Large B-Cell, Diffuse / Q000175:diagnosis / Q000473:pathology; D008232:Lymphoproliferative Disorders / Q000175:diagnosis* / Q000473:pathology; D014066:Palatine Tonsil / Q000473:pathology* / Q000821:virology; D011183:Postoperative Complications / Q000175:diagnosis*; D012333:RNA, Messenger / Q000032:analysis; D012367:RNA, Viral / Q000032:analysis; D012189:Retrospective Studies; D013997:Time Factors; D014067:Tonsillar Neoplasms / Q000175:diagnosis* / Q000473:pathology; D014068:Tonsillectomy
D000998:Antiviral Agents; D012333:RNA, Messenger; D012367:RNA, Viral