Posttransplantation lymphoproliferative disease: Proposed imaging classification

Juan C. Camacho, Courtney Coursey Moreno, Peter A. Harri, Diego A. Aguirre, William E. Torres, Pardeep Kumar Mittal

Research output: Contribution to journalArticle

22 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)2025-2038
Number of pages14
JournalRadiographics
Volume34
Issue number7
DOIs
Publication statusPublished - Jan 1 2014
Externally publishedYes

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ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

Cite this

Camacho, J. C., Moreno, C. C., Harri, P. A., Aguirre, D. A., Torres, W. E., & Mittal, P. K. (2014). Posttransplantation lymphoproliferative disease: Proposed imaging classification. Radiographics, 34(7), 2025-2038. https://doi.org/10.1148/rg.347130130