Age / Sex : 33 / F

Chief complaint : Hip & thigh pain, left

PHx: Kidney transplantation, 3 years ago

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.