Weekly Case

Title : Case 589

Age / Sex : 33 / F


Chief complaint : Hip & thigh pain, left


PHx: Kidney transplantation, 3 years ago



What is your impression?

Two weeks later, you can see the final diagonosis with a brief discussion of this case (Please submit only one answer).

Courtesy : Hye Jung Choo, 
Inje University Busan Paik Hospital



Discussion


Answer:  Post-transplantation lymphoproliferative disease (PTLD)


 


Findings:


Sagittal T1- and T2- weighted images show a low signal intense mass at L4 vertebral body with extension to the anterior epidural space.


Sagittal T2-weighted sagittal image show the heterogeneous signal intense masses at the posterior aspects of T2 and T10 vertebral bodies


 


Differential Diagnosis:


 


 


Discussion:


 


Post-transplantation lymphoproliferative disease (PTLD)



  • Cx of solid organ transplantation and allogeneic hematopoietic stem cell transplantation

  • Incidence: varies

    • Heart, heart-lung, and small bowel transplants >> kidney and liver transplants

    • 6~1.5% in KTP patients

    • Asso with Epstein-Barr virus infection of B cells

    • consequence of reactivation of the virus post transplantation

    • primary EBV infection.



  • Spectrum of PTLD

    • Benign lymphoid hyperplasia ~ poorly differentiated lymphoma



  • In general, PTLD most commonly involves the allograft itself or the region of the allograft

    • Liver after liver transplantation

    • Lung after lung transplantation

    • GI track after kidney transplantation

    • Bimodal manifestation

    • Early peak within the first year after transplantation

    • later peak 4–5 years after transplantation



  • Treatment options

    • Reducing immunosuppression, chemotherapy, radiation therapy, and surgical resection of isolated lesions.




 


 


References:


Camacho JC1, Moreno CC, Harri PA, Aguirre DA, Torres WE, Mittal PK. Posttransplantation lymphoproliferative disease: proposed imaging classification. Radiographics 2014;34:2025-38.



Correct Answer
Total applicants 32 Correct answers 17
Name Institution
김기욱 국군대전병원, 전문의
김창현 전문의
강지희 서울대학교병원, 전공의
이영선 전문의
김동환 서울아산병원, 전문의
한유비 전문의
이혜란 전문의
석지현 전문의
박상옥 안산21세기병원, 전문의
이지현 삼성서울병원, 전문의
김미선 전문의
권소이 전문의
이연옥 선한목자병원, 전문의
박준동 뿌리병원, 전문의
김보람 전문의
임윤진 전공의
이은채 전문의


  • 관리자 ( 2018-10-08 13:54:46 )
    PHx: Kidney transplantation, 3 years ago
    --과거력이 있었는데 제가 올릴 때 과거력 내용이 빠진 것 같습니다. 죄송합니다.

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