title: Post-transplant lymphoproliferative disease presenting as a mass in the left ventricle in a heart transplant recipient at long-term follow-up.
abstract: Neoplasms are among the most common solid-organ transplant complications, occurring in 11.7% of all transplant recipients and in 6% to 15% of heart transplant recipients, according to early studies. The skin and lips are the most common sites for neoplasms, but they also appear in the setting of post-transplant lymphoproliferative disease. Post-transplant lymphoproliferative disease (PTLD) is one of the most serious complications of long-term immunosuppression after transplantation. Herein we report the case of a 53-year-old man who underwent orthotopic heart transplantation for Chagas cardiomyopathy and had developed a mass in the left ventricle with symptomatic ventricle outflow obstruction. The patient was initially treated with anti-coagulation but his condition worsened and he was given emergency surgery to remove the mass. The patient recovered well and histologic assessment revealed PTLD as the etiologic culprit. Lymphoproliferative disorders are the second most frequently identified malignant neoplasm after heart transplantation. B-cell tumors are the most common histologically and are associated with infection by Epstein-Barr virus in 80% to 90% of cases.
authors.affiliation: Department of Cardiovascular Surgery, Universidade Federal de São Paulo, São Paulo, Brazil.
authors.forename: José H F
authors.initials: JH
authors.lastname: Palma
authors.forename: José C S
authors.initials: JC
authors.lastname: Guilhen
authors.forename: Diego F
authors.initials: DF
authors.lastname: Gaia
authors.forename: Andre
authors.initials: A
authors.lastname: Teles
authors.forename: Carlos A
authors.initials: CA
authors.lastname: Teles
authors.forename: Joao N R
authors.initials: JN
authors.lastname: Branco
authors.forename: Enio
authors.initials: E
authors.lastname: Buffolo
mesh_terms: D002598:Chagas Cardiomyopathy / Q000188:drug therapy / Q000601:surgery*; D004562:Electrocardiography; D017809:Fatal Outcome; D005500:Follow-Up Studies; D006338:Heart Neoplasms / Q000473:pathology*; D016027:Heart Transplantation / Q000009:adverse effects*; D006352:Heart Ventricles / Q000473:pathology*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008232:Lymphoproliferative Disorders / Q000000981:diagnostic imaging / Q000473:pathology*; D009682:Magnetic Resonance Spectroscopy; D008297:Male; D008875:Middle Aged; D009593:Nitroimidazoles / Q000627:therapeutic use; D011183:Postoperative Complications / Q000473:pathology; D012008:Recurrence; D013997:Time Factors; D014463:Ultrasonography
chemical_list: D007166:Immunosuppressive Agents; D009593:Nitroimidazoles; C009999:benzonidazole