Otolaryngological manifestations of posttransplant lymphoproliferative disorder in pediatric thoracic transplant patients.
OBJECTIVE
To identify the otolaryngological manifestations of posttransplant lymphoproliferative disorder (PTLD) in pediatric heart and lung transplant recipients.


METHODS
A 14-year retrospective case series review (1990-2003) of children less than 18 years of age presenting with PTLD after receiving orthotopic heart and lung transplants at St. Louis Children's hospital (St. Louis, MO, USA).


RESULTS
One hundred ninety seven cardiac and 246 pulmonary transplant patients were included in this review. Thirteen heart transplant patients developed PTLD with 39% (5/13) presenting in the head and neck. Thirty-two lung transplant patients developed PTLD with 25% (8/32) presenting in the head and neck. PTLD in cardiac transplants most often presented as adenotonsillar hypertrophy or cervical lymphadenopathy. The sinonasal cavity was the most common site of head and neck PTLD in pulmonary transplants patients.


CONCLUSIONS
This study suggests that head and neck involvement is more common than currently reported in the literature. As thoracic organ transplants become more frequent in children, otolaryngologists caring for this population should maintain a high index of suspicion for any suggestive findings. Evaluation must include tissue biopsy, as histopathologic examination is required for diagnosis.
Herrmann
Brian W
BW
Washington University School of Medicine, Department of Otolaryngology-Head and Neck Surgery, St. Louis, MO, USA. bherrmann@childrensent.com
Sweet
Stuart C
SC
Hayashi
Robert J
RJ
Canter
Charles E
CE
White
Frances V
FV
Lieu
Judith E C
JE
D000234:Adenoids / Q000473:pathology; D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D016027:Heart Transplantation / Q000009:adverse effects*; D006801:Humans; D006984:Hypertrophy; D007165:Immunosuppression Therapy / Q000009:adverse effects*; D007223:Infant; D007231:Infant, Newborn; D016040:Lung Transplantation / Q000009:adverse effects*; D008198:Lymph Nodes / Q000473:pathology; D008232:Lymphoproliferative Disorders / Q000209:etiology* / Q000473:pathology; D009333:Neck; D014066:Palatine Tonsil / Q000473:pathology; D010254:Paranasal Sinus Diseases / Q000209:etiology* / Q000473:pathology; D012189:Retrospective Studies; D020181:Sleep Apnea, Obstructive / Q000209:etiology