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Weekly Chest CasesArchive of Old Cases

Case No : 739 Date 2011-12-28

  • Courtesy of Nara Kim, Semin Chong / Chung-Ang university hospital
  • Age/Sex 24 / M
  • Chief ComplaintNeck discomfort. History of allo-PBSCT (peripheral blood stem cell transplantation) for aplastic anemia
  • Figure 1
  • Figure 2
  • Figure 3

Figure 1

Diagnosis With Brief Discussion

Diagnosis
Posttransplantation lymphproliferative disorder
Radiologic Findings
Chest CT shows multiple variable sized, enlarged axillary, mediastinal and hilar lymph nodes.
Neck CT shows multiple enlarged cervical lymph nodes in the bilateral level I
Brief Review
Posttransplantation malignancies in hematopoietic stem cell transplantation (HSC) patients are seven times more common than primary cancer in the general population. Posttransplantation malignancies include solid tumors, hematologic neoplasms, and posttransplantation lymphoproliferative disorder (PTLD).
PTLD represents a heterogeneous group of Epstein Barr virus related lymphoid tumors, including lymphoid hyperplasia and lymphoid neoplasia, which occur in the setting of chronic immunosuppression after solid organ transplantation. PTLD occurs as early as 1 month after transplantation. PTLD occurs in approximately 2% of HSC transplantation patients.
In our case, cervical lymph node proved to diffuse large B-cell lymphoma at biopsy. Lymphoma in transplant patients shows aggressive atypical features unlike the lymphomas that occur in the general population. Because these lymphomas are almost always fatal if untreated, awareness of their imaging appearance will prompt early diagnosis and intervention.
Extranodal disease (81%) is more common than lymphadenopathy (22%) in patients with PTLD. Single or multiple organ masses are the characteristic radiographic presentations of PTLD. Any of the solid organs, hollow viscera, abdominal, retroperitoneal and iliac lymph nodes, retroperitoneal musculature, or peritoneum of the abdomen can be involved in PTLD. In chest CT images, manifestations of PTLD usually consist of multiple pulmonary nodules or hilar and mediastinal lymphadenopathy or both.
References
1. Tom�s Franquet, Nestor L. M�ller, Kyung Soo Lee, Ana Gim�nez, and Julia D. Flint Pictorial Essay: High-Resolution CT and Pathologic Findings of Noninfectious Pulmonary Complications After Hematopoietic Stem Cell Transplantation AJR February 2005 184:629-637
2. Posttransplantation Lymphoproliferative Disorder of the Head and Neck: Imaging Features in Seven Adults Radiology August 2000 216:363-369
3. Toni L. Meador, Thorsten L. Krebs, Jade J. Wong You Cheong, Barry Daly, Susan Keay, and Stephen Bartlett Imaging Features of Posttransplantation Lymphoproliferative Disorder in Pancreas Transplant Recipients AJR January 2000 174:121-124
Keywords
mediastinum, lymphoproliferative disease,

No. of Applicants : 95

▶ Correct Answer : 71/95,  74.7%
  • - James Paget Hospital , U.K , United Kingdom nabil mahmood
  • - Fukuyama daiichi Hospital , Japan Mototsugu Saeki
  • - Youngdong Hospital , Korea (South) Sang Min Lee
  • - radiologist, aditya imaging centre , India vivek patel
  • - XiangYa hospital , China yu xia
  • - Diskapi Yildirim Beyazit Hospital, Ankara , Turkey Meric Tuzun
  • - Kurashiki Seijin-byo Center , Japan Akihiro Tada
  • - Inha University Hospital , Korea (South) Ju Won Lee
  • - UWO , Canada S Lee
  • - CHA Bundang hospital , Korea (South) Hyerin Kim
  • - Dong-A University Hospital , Korea (South) Ji-yeon Han
  • - Hopital Louis Pradel LYON , France matthieu ROUSSET
  • - Seoul National University Hospital , Korea (South) YongSub Song
  • - DRRPGMC KANGRA AT TANDA , India Dinesh Sood
  • - Korea university , Korea (South) Kun Woo Kang
  • - chp st martin , France Mariotte benoit
  • - BMC baroda , India mahesh shettennavar
  • - Kyung Hee Universitiy Hospital at Gangdong , Korea (South) Seong Yun
  • - McGill University Health Center , Canada Alexandre Semionov
  • - Kyung Hee University Hospital , Korea (South) Ji Hye Jang
  • - Ewha womens university, mok dong hospital , Korea (South) Hyun Hae Cho
  • - University of British Columbia , Canada Amr Ajlan
  • - Yonsei University College of Medicine, Shinchon Severance hospital , Korea (South) Young Joo Suh
  • - Deptt of Radiodiagnosis & Imaging, PGIMER chandigarh , India Ram Galwa
  • - Sunchun university hospital, Bucheon , Korea (South) So Young Bae
  • - Montreal Chest Institute , Canada Faiz Khan
  • - , Korea (South) 議고˜„
  • - UZ GASTHUISBERG , Belgium Johan COOLEN
  • - All India Institute of medical sciences , India Justin Moses
  • - Onomichi municipal hospital , Japan Hirofumi Mifune
  • - Montreal , Canada D J
  • - Clinica Alemana de Santiago , Chile Claudio Silva
  • - Asan medical center , Korea (South) Hyun Joo Lee
  • - Asan Medical Center , Korea (South) Sang Min Lee
  • - Asan Medical Center, Ulsan University , Korea (South) Mi Young Kim
  • - Asan Medical Center , Korea (South) Hye Jeon Hwang
  • - MASAN , Korea (South) Kim Sang Hyeon
  • - Song-do Hospital , Korea (South) Ji-young Yun
  • - Yokohama-asahi-chuo-general hospital , Japan Kyoko Nagai
  • - CHU NANCY , France, Metropolitan LEGOU Francois
  • - Chiba University Hospital , Japan Hajime Yokota
  • - Cl�nica Alemana-Universidad del Desarrollo , Chile Patricio Maximiliano Latorre Brajovic
  • - Hotel-Dieu Montreal , Canada nicolas gautier
  • - Hopital Louis Pradel Lyon , France Clement Proust
  • - Sejong general hospital , Korea (South) Dong Jae Shim
  • - fmmc , India subas kandimalla
  • - korea university , Korea (South) Hyelarn Lee
  • - Ewha Womans University Hospital , Korea (South) YOOKYUNG KIM
  • - Iwate Med.Univ , Japan Kikuchi Koyo
  • - Hangang Sacred Heart Hospital , Korea (South) Eil Seong Lee
  • - Seoul St Mary Hospital , Korea (South) Chae Lim
  • - Asan Medical Center , Korea (South) Ji Eun Kim
  • - Bupyong Serim Hospital , Korea (South) Hee Seok Choi
  • - radiology , Iran barat borhani
  • - Virgin Mary Hospital Burgas , Bulgaria VLADISLAV RUSINOV
  • - IRSA La Rochelle France , France Denis Chabassiere
  • - Ondokuz Mayis University , Turkey Cetin Celenk
  • - IRSA , France jean-luc BIGOT
  • - clinique de SAVOIE , France, Metropolitan gay-depassier philippe
  • - IRCCS Istituto Oncologico - Bari , Italy Carlo Florio
  • - Ishikawa Matto Central Hospital , Japan Manabu Akimoto
  • - jaslok hospital & research centre mumbai , India JAINENDRA JAIN
  • - Chuncheon Sacred Heart Hospital , Korea (South) Park Su-young
  • - NASA SCANS , India RAKESH BHATIA
  • - Saint Malo , France jean-baptiste Noel
  • - Mallinckrodt Institute of Radiology , United States Naganathan Mani
  • - CHRU lille , France manuel toledano
  • - Kizawa Memorial Hospital , Japan Yo Kaneko
  • - Azienda Ospedaliera San Gerardo , Italy Gabriele DAndrea
  • - Private sector , Greece Vasilios Tzilas
  • - Okayama university , Japan Mayu Uka
▶ Correct Answer as Differential Diagnosis : 13/95,  13.7%
  • - Paramount Diagnostic & Research Centre , India Mahavir Swami
  • - Az Osp Santa Maria Terni , Italy angelo carloni
  • - Kohka Public Hospital , Japan Akitoshi Inoue
  • - NMC, sunder lal jain hospital , India SANJEEV VACHHER
  • - China Medical University ,Taiwan,R.O.C. , Taiwan Jun Jun Yeh
  • - Oita University, Faculty of Medicine , Japan Fumito Okada
  • - Onomichi municipal hospital , Japan Ryotaro Kishi
  • - CHRU Lille , France Paul Lebert
  • - Homs National Hospital , Syria Rami Abou Zalaf
  • - Asan Medical Center , Korea (South) Eun Kim
  • - NDMVP Nashik , India Imran Jindani
  • - Medical College Chest Hospital,Thrissur,Kerala , India Raveendran TK
  • - Pneumologia Universitaria, Policlinico di Bari , Italy Mario Damiani
▶ Semi-Correct Answer : 2/95,  2.1%
  • - Retd. Prof Thoracic Surgery B.J.MEDIDCAL COLLEGE Punr India;Visitng Prof of Thoracic Surgery KLE University Belgaum , India Bankim Amin
  • - SAISEIKAI KURIHASHI HOSPITAL , Japan YASUO OOKUBO
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