Brain tumor as an unusual presentation of posttransplant lymphoproliferative disorder.
OBJECTIVE
Posttransplant lymphoproliferative disorder following solid organ transplant is a lifethreatening form of posttransplant malignancy. Its occurrence is typically associated with Epstein-Barr virus and profound immunosuppressive therapy. We describe a case of posttransplant lymphoproliferative disorder in the brain parenchyma, 4 years after renal transplant.


METHODS
A 23-year-old man was evaluated for generalized headache 4 years after receiving a deceased donor renal transplant. After initial immunosuppression with tacrolimus and prednisolone, mycophenolate mofetil was added for maintenance immunosuppression. A tumor in the right occipitoparietal lobe was detected by magnetic resonance imaging and excised. Immunohistochemical testing of the tumor revealed B-cell marker and Epstein-Barr virus. After surgery, the dosage of immunosuppressive drugs was reduced, and the patient was treated with chemotherapy and radiotherapy. Our patient is well after treatment.


CONCLUSIONS
Reduction in immunosuppressive therapy is an important component of treatment for Epstein-Barr virus-positive posttransplant lymphoproliferative disorder and may lead to remission in early disease. If reduced immunosuppression fails to control early disease, cytotoxic chemotherapy, surgery and radiotherapy, antiviral therapies, and cell-based therapies are other options for treatment.
Transplant Research Center, Shiraz University of Medical Sciences, Shiraz, Iran. negarazarpira@yahoo.com
Negar
N
Azarpira
Simin
S
Torabineghad
Mohamad
M
Rakei
D001932:Brain Neoplasms / Q000473:pathology / Q000628:therapy / Q000821:virology*; D017024:Chemotherapy, Adjuvant; D016371:Cranial Irradiation; D003399:Craniotomy; D020031:Epstein-Barr Virus Infections / Q000150:complications* / Q000209:etiology / Q000628:therapy; D006801:Humans; D007150:Immunohistochemistry; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D016030:Kidney Transplantation / Q000009:adverse effects*; D008232:Lymphoproliferative Disorders / Q000473:pathology / Q000628:therapy / Q000821:virology*; D008279:Magnetic Resonance Imaging; D008297:Male; D009778:Occipital Lobe / Q000473:pathology / Q000821:virology*; D010296:Parietal Lobe / Q000473:pathology / Q000821:virology*; D018714:Radiotherapy, Adjuvant; D016896:Treatment Outcome; D055815:Young Adult
D007166:Immunosuppressive Agents