Posttransplant lymphoproliferative disorder in the wall of a lymphocele: a case report.
Posttransplant lymphoproliferative disorder (PTLD) is a well-known complication of renal transplantation with increased incidence after introduction of more powerful immunosuppressive drugs. Presenting symptoms are nonspecific; some patients may be entirely asymptomatic. Herein we have reported a case of PTLD arising in the lymphocele wall presenting with B-symptoms and deterioration of graft function. A 62-year-old-female with end-stage renal disease secondary to Balkan endemic nephropathy and positive Epstein-Barr virus (EBV) serology before transplantation received a renal transplant from a deceased donor. Six months after transplantation she was admitted to the hospital with a 1-week history of malaise, weight loss, anorexia, night sweats, and febrile episodes. Multisliced computed tomography demonstrated a cystic structure at the renal hilus. Graft function deteriorated, so the patient underwent puncture of the lymphocele. Urgent graftectomy was necessary to stop the bleeding. Pathohistology demonstrated EBV-positive, CD20-positive PTLD. The patient received 6 cycles of chemotherapy and continued on hemodialysis. We concluded that a high index of suspicion for PTLD should be maintained when evaluating lymphoceles arising in the later posttransplantation period. Irrespective of their imaging features, biopsy should be performed to exclude PTLD.
Basic-Jukic
N
N
Department of Dialysis, UHC Zagreb, Zagreb, Croatia.
Kes
P
P
Coric
M
M
Kastelan
Z
Z
Pasini
J
J
Bubic-Filipi
L
L
D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007676:Kidney Failure, Chronic / Q000276:immunology / Q000601:surgery*; D016030:Kidney Transplantation / Q000009:adverse effects*; D008210:Lymphocele / Q000601:surgery*; D008232:Lymphoproliferative Disorders / Q000473:pathology* / Q000601:surgery; D008875:Middle Aged; D009392:Nephrectomy; D011183:Postoperative Complications / Q000473:pathology*; D017582:Renal Replacement Therapy
D007166:Immunosuppressive Agents