Posttransplantation lymphoproliferative disease: proposed imaging classification.
Posttransplantation lymphoproliferative disease (PTLD) is the second most common tumor in adult transplant recipients. Most cases of PTLD are attributed to Epstein-Barr virus. Decreased levels of immunosurveillance against this tumor virus as a result of immunosuppressive regimens are thought to account for most cases of PTLD. Histologically, PTLD ranges from relatively benign lymphoid hyperplasia to poorly differentiated lymphoma, and tissue sampling is required to establish the subtype. The frequency of PTLD varies depending on the type of allograft and immunosuppressive regimen. PTLD has a bimodal manifestation, with most cases occurring within the first year after transplantation and a second peak occurring 4-5 years after transplantation. Patients are often asymptomatic or present with nonspecific symptoms, and a mass visible at imaging may be the first clue to the diagnosis. Imaging plays an important role in identifying the presence of disease, guiding tissue sampling, and evaluating response to treatment. The appearance of PTLD at imaging can vary. It may be nodal or extranodal. Extranodal disease may involve the gastrointestinal tract, solid organs, or central nervous system. Solid organ lesions may be solitary or multiple, infiltrate beyond the organ margins, and obstruct organ outflow. Suggestive imaging findings should prompt tissue sampling, because knowledge of the PTLD subtype is imperative for appropriate treatment. Treatment options include reducing immunosuppression, chemotherapy, radiation therapy, and surgical resection of isolated lesions.
From the Abdominal Imaging Division, Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1365 Clifton Rd NE, Suite AT-627, Atlanta, GA 30322 (J.C.C., C.C.M., P.A.H., W.E.T., P.K.M.); and Abdominal Imaging Division, Department of Imaging, Fundación Santa Fe de Bogotá University Hospital, Bogotá, Colombia (D.A.A.).
Juan C
JC
Camacho
Courtney Coursey
CC
Moreno
Peter A
PA
Harri
Diego A
DA
Aguirre
William E
WE
Torres
Pardeep K
PK
Mittal
D003952:Diagnostic Imaging; D006801:Humans; D016867:Immunocompromised Host; D007165:Immunosuppression Therapy / Q000009:adverse effects; D007166:Immunosuppressive Agents / Q000009:adverse effects; D008232:Lymphoproliferative Disorders / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology; D016377:Organ Transplantation / Q000009:adverse effects*; D012307:Risk Factors
D007166:Immunosuppressive Agents