Early Onset Polymorphic Post-transplant Lymphoproliferative Disease Mimicking a Solitary Necrotizing Abscess in a Graft Liver

다국어 초록 (Multilingual Abstract)

Although post-transplantation lymphoproliferative disease (PTLD) after liver transplantation is very rare, its prognosis is worse than that of PTLD following other types of solid organ transplantation. Here, we report a rare case of early onset polymorphic PTLD in a graft liver occurring five months after deceased-donor liver transplantation due to hepatocellular carcinoma and hepatitis C virus infection. Initially, findings from contrast-enhanced magnetic resonance imaging mistakenly suspected the lesion was a necrotizing abscess with central necrosis. However, 18F-fluorodeoxyglucose positron emission tomography and biopsy findings confirmed an Epstein-Barr virus (EBV)-associated, B cell type polymorphic PTLD with central necrosis. Our case suggests regular monitoring of EBV serologic status for liver transplant recipients who were initially in an EBV seronegative state. Although early-onset PTLD is very rare after liver transplantation, PTLD should be suspected when recipients show the seroconversion for EBV proteins and the development of new tumors with various clinical presentations.

참고문헌 (Reference)

1 김혜영, "Safety of reduced dose of mycophenolate mofetil combined with tacrolimus in living-donor liver transplantation" 대한간학회 20 (20): 291-299, 2014

2 Petrara MR, "Posttransplant lymphoproliferative disorders: from epidemiology to pathogenesis-driven treatment" 369 : 37-44, 2015

3 Yoon SO, "Posttransplant lymphoproliferative disorders: clinicopathological analysis of 43 cases in a single center, 1990-2009" 26 : 67-73, 2012

4 Jain A, "Posttransplant lymphoproliferative disorders in liver transplantation:a 20-year experience" 236 : 429-436, 2002

5 Dierickx D, "Posttransplant lymphoproliferative disorders following liver transplantation: where are we now?" 21 : 11034-11043, 2015

6 Kamdar KY, "Posttransplant lymphoproliferative disease following liver transplantation" 16 : 274-280, 2011

7 Al-Mansour Z, "Post-transplant lymphoproliferative disease (PTLD): risk factors, diagnosis, and current treatment strategies" 8 : 173-183, 2013

8 Jagadeesh D, "Post transplant lymphoproliferative disorders: risk, classification, and therapeutic recommendations" 13 : 122-136, 2012

9 Evens AM, "Multicenter analysis of 80 solid organ transplantation recipients with post-transplantation lymphoproliferative disease:outcomes and prognostic factors in the modern era" 28 : 1038-1046, 2010

10 Lauro A, "Managing the challenge of PTLD in liver and bowel transplant recipients" 169 : 157-172, 2015

11 Leblond V, "Lymphoproliferative disorders after liver transplantation" 40 : 728-735, 2004

12 Jiang Y, "Liver transplantation and subsequent risk of cancer: findings from a Canadian cohort study" 14 : 1588-1597, 2008

13 Cazzola M, "Introduction to a review series: the 2016 revision of the WHO classification of tumors of hematopoietic and lymphoid tissues" 127 : 2361-2364, 2016

14 Dierickx D, "How I treat posttransplant lymphoproliferative disorders" 126 : 2274-2283, 2015

15 Morton LM, "Hepatitis C virus infection and risk of posttransplantation lymphoproliferative disorder among solid organ transplant recipients" 110 : 4599-4605, 2007

16 Nieters A, "Hepatitis C and risk of lymphoma: results of the European multicenter case-control study EPILYMPH" 131 : 1879-1886, 2006

17 Martínez-Calle N, "First-line use of rituximab correlates with increased overall survival in late post-transplant lymphoproliferative disorders: retrospective, single-centre study" 98 : 38-43, 2017

18 Izadi M, "Features, predictors and prognosis of lymphoproliferative disorders post-liver transplantation regarding disease presentation time: report from the PTLD" 16 : 39-47, 2011

19 Hatton O, "Emerging therapeutic strate gies for Epstein-Barr virus+ post-transplant lymphoproliferative disorder" 16 : 220-229, 2012

20 Parker A, "Diagnosis of post-transplant lymphoproliferative disorder in solid organ transplant recipients - BCSH and BTS Guidelines" 149 : 675-692, 2010