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Weekly Chest CasesArchive of Old Cases

Case No : 1372 Date 2024-02-07

  • Courtesy of Hye Soo Cho, Ji Young Lee, Woo Hyeon Lim / Seoul National University Hospital
  • Age/Sex 59 / M
  • Chief ComplaintFever / Brief history: Myelodysplastic syndrome, Acute myeloid leukemia, s/p Haplo-PBSCT
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4
  • Figure 5

Diagnosis With Brief Discussion

Diagnosis
Posttransplant lymphoproliferative disorder
Radiologic Findings
Fig 1. Chest PA shows multifocal ill defined opacities in both lung fields.
Fig 2. Chest CT scan shows ill-defined GGOs in both lung.
Fig 3-5. In chest CT, multifocal GGO and consolidation have been gradually aggravated during follow-ups despite the empirical treatment.
Brief Review
Post-transplantation lymphoproliferative disorders (PTLDs) are defined as lymphomas that occur after transplantation. PTLD is the second most common tumor in adult transplant recipients. Recipients of solid-organ or allogeneic hematopoietic stem-cell transplants have an increased risk of cancers related to immunosuppression and the Epstein–Barr virus (EBV) — in particular, lymphomas. PTLD is most prevalent during the first year following transplantation. In the adult population, recipients of kidney transplants have the lowest incidence of PTLD (0.8 to 2.5%), followed by recipients of pancreatic transplants (0.5 to 5.0%), liver transplants (1.0 to 5.5%), heart transplants (2.0 to 8.0%), and lung transplants (3.0 to 10.0%). For allogeneic hematopoietic stem-cell transplants, the incidence depends mainly on the degree of HLA matching and the highest incidence of PTLD is observed with haploidentical allogeneic hematopoietic stem-cell transplantation.
A pulmonary mass and nodules, either solitary or multiple, are the most common thoracic manifestation of PTLD. Other intrathoracic manifestations include lymph node enlargement, airspace consolidation, and, less commonly, pleural effusion, pericardial effusion, thymic enlargement, and chest wall soft-tissue involvement. Many of the thoracic manifestations are nonspecific for PTLD and can also be seen with transplantation-related complications, particularly infection. Acute rejection may manifest as ground-glass opacities or airspace consolidation, and, although PTLD usually does not develop rapidly, its presence has been reported as early as 1 week following transplantation. FDG PET/CT can increase sensitivity and specificity for the diagnosis; however, biopsy is still necessary for confirmation.
References
1. Dierickx D, Habermann TM. Post-Transplantation Lymphoproliferative Disorders in Adults. N Engl J Med. 2018 Feb 8;378(6):549-562.
2. Borhani AA, Hosseinzadeh K, Almusa O, Furlan A, Nalesnik M. Imaging of posttransplantation lymphoproliferative disorder after solid organ transplantation. Radiographics. 2009 Jul-Aug;29(4):981-1000.
3. Camacho JC, Moreno CC, Harri PA, Aguirre DA, Torres WE, Mittal PK. Posttransplantation lymphoproliferative disease: proposed imaging classification. Radiographics. 2014 Nov-Dec;34(7):2025-38.

Keywords

No. of Applicants : 80

▶ Correct Answer : 5/80,  6.3%
  • - The University of Tokyo Hospital , Japan JUN KANZAWA
  • - Vita Hospital , Brazil DIOGO LAGO PINHEIRO
  • - university of montreal , Canada Andrei Bogdan Gorgos I
  • - Ajou University Hospital , Korea (South) HAEIN LEE
  • - The Catholic University of Korea Yoeuido St. Mary , Korea (South) CHAWOONG JEON
▶ Correct Answer as Differential Diagnosis : 16/80,  20.0%
  • - medical scanning , Japan HIROAKI ARAKAWA
  • - Kyoto City Hospital , Japan YUSUKE UTSUNOMIYA
  • - Secomedic Hospital , Japan FUMINORI MIYOSHI
  • - Narayana Multispeciality Hospital Jaipur Rajasthan , India JAINENDRA JAIN
  • - Kyoto University Hospital , Japan YASUHISA KURATA
  • - Other , Korea (South) CHAEHUN LIM
  • - Tokyo Medical and Dental University , Japan MIKIYA FUJII
  • - University of Tsukuba, Dept of Radiology , Japan MANABU MINAMI
  • - Osaka metropolitan university Hospital , Japan TATSUSHI OURA
  • - Korea University Anam Hospital , Korea (South) KYU-CHONG LEE
  • - Paras hospital, Panchkula , India SHALEEN RANA
  • - Kyoto University , Japan SHO KOYASU
  • - Kantou Rousai Hospital , Japan KAORU SUMIDA
  • - Nerimahikarigaoka hospital , Japan TAKANA HAYASHI
  • - Matsunami General Hospital , Japan TARO TAKEDA
  • - , Korea (South) JIN WOO YOON
▶ Semi-Correct Answer : 1/80,  1.3%
  • - , Uzbekistan DINORA IBRAGIMOVA
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