Posttransplant lymphoproliferative disorders presenting at sites of previous surgical intervention.
Early diagnosis of posttransplant lymphoproliferative disorder (PTLD) requires a high level of clinical suspicion. PTLD occurs mainly in the lymphoid tissue, allograft organ, bowel, and central nervous system. The diagnosis may not be considered initially when disease is localized to other sites. Retrospective review of the PTLD series at the University of Pittsburgh Medical Center showed that 4 of 418 patients (1%) presented with signs and symptoms localized to sites of previous surgical intervention (choledochojejunostomy site, ileosigmoid anastomotic site, site of saphenous vein stripping, and intrabiliary site of percutaneous transhepatic catheter). All patients showed symptomatic, Epstein-Barr virus-positive B-cell PTLD of varying histology. Three of four patients ultimately died with tumor, and the fourth died of unrelated causes. PTLD should be included in the differential diagnosis when clinical signs and symptoms localize to anastomotic sites, surgical incision sites, or sites of longstanding catheter placement in immunosuppressed organ transplant recipients.
Doria
Cataldo
C
Department of Surgery, University of Pittsburgh, Thomas E. Starzl Transplantation Institute, 4th Floor, Falk Clinic, 3601 Fifth Avenue, Pittsburgh, PA 15213. doriac@ISMETT.edu
Marino
Ignazio R
IR
Scott
Victor L
VL
Jaffe
Ronald
R
Minervini
Marta I
MI
Zajko
Albert
A
Nalesnik
Michael A
MA
D000368:Aged; D002675:Child, Preschool; D020031:Epstein-Barr Virus Infections / Q000150:complications; D017809:Fatal Outcome; D005260:Female; D016027:Heart Transplantation / Q000009:adverse effects*; D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects*; D008232:Lymphoproliferative Disorders / Q000209:etiology* / Q000821:virology; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D012086:Reoperation; D012189:Retrospective Studies