Cutaneous involvement of polymorphic post‐transplant lymphoproliferative disorder in a child after liver transplantation

Chen, Kuan‐Yu; Lin, Chien‐Yio; Kuo, Tseng‐Tong; Shih, Lee‐Yung; Chang, Chih‐Hao; Chen, Wei‐Ti; Yang, Chin‐Yi

doi:10.1111/pde.13903

Cited by 5 publications

(13 citation statements)

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“…The median time for diagnosis of primary CNS PTLD following transplantation is 4.4 years [ 18 ], and our patient developed late onset (more than 1-year post-transplant) polymorphic PTLD after 11 years. Other cases with late onset (after 10 years) post-transplantation have been documented by Cavaliere and Evens [ 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 ].…”

Section: Discussionmentioning

confidence: 99%

“…Lesions tend to be multifocal, lobar, and supratentorial, and rarely present in the infratentorial region or in the spinal cord. The main affected CNS structures include the lobes (88%), basal ganglia (39%), and the periventricular area (72%), followed by the brainstem and cerebellum [ 8 , 9 , 10 ]. Less commonly, there is the involvement of the corpus callosum, thalami, or concurrent meningeal/ependymal enhancement [ 9 ].…”

Section: Discussionmentioning

confidence: 99%

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Post-Transplant Lymphoproliferative Disorder: A Rare Case of CNS Involvement following Renal Transplant

Feindt

Lara-Velazquez

Alkhasawneh

et al. 2022

JCM

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Background: Post-transplant lymphoproliferative disorders (PTLD) are rare immunosuppression complications affecting 5% of transplant patients. Isolated central nervous system (CNS)-PTLD without nodal or extra-nodal organ involvement is rarely reported and is difficult to diagnose due to the non-specific clinical manifestations and imaging features overlapping with other common CNS lesions. Case presentation: We present a case of a 72-year-old female subjected to a renal transplant 11 years ago with progressively worsening headaches and confusion. Imaging revealed vasogenic edema in the left frontal and bilateral temporal lobes. She was subjected to a craniotomy and excisional biopsy to obtain tissue for diagnostic and therapeutic interventions. Pathology examination showed atypical EBV-positive lymphoplasmacytic infiltrate, consistent with Polymorphic type PTLD. Conclusions: Patients diagnosed with PTLD need to have close monitoring of immunosuppressive medications while in the hospital. Early diagnosis is essential for patient survival with PTLD, as their health can deteriorate fast.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Post-Transplant Lymphoproliferative Disorder: A Rare Case of CNS Involvement following Renal Transplant

Feindt

Lara-Velazquez

Alkhasawneh

et al. 2022

JCM

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“…Risk for melanoma is higher in pediatric SOTR than the general population, with a recently reported standardized incidence ratio of 3, which is similar to adult SOTR risk. 23,107 Melanoma in adults can be recognized when using the "ABCDE" criteria, looking for Asymmetry, Border irregularity, Color variation, Diameter Polymorphic PTLD can present in the skin with patches and nodules, 111 and cutaneous B-cell PTLD is often nodular. 109 1.12 | Risk factors…”

Section: Melanomamentioning

confidence: 99%

“…Morphology varies, including classic presentations of mycosis fungoides (typically eczematous or poikilodermatous patches), 109 as well as folliculotropic (papules at hair follicles with associated alopecia) 110 subtypes of T‐cell lymphomas. Polymorphic PTLD can present in the skin with patches and nodules, 111 and cutaneous B‐cell PTLD is often nodular 109 …”

Section: Introductionmentioning

confidence: 99%

Post‐transplant malignancies in pediatric organ transplant recipients

Robinson

Coughlin

Chanchlani

et al. 2020

Pediatric Transplantation

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The majority of cancer diagnoses in pediatric solid organ transplant recipients (SOTRs) are post‐transplantation lymphoproliferative disorders (PTLD) or skin cancers. However, pediatric SOTRs are also at significantly elevated risk for multiple other solid and hematological cancers. The risks of specific cancers vary by transplanted organ, underlying disease, and immunosuppression factors. More than one‐quarter of pediatric SOTRs develop cancer within 30 years of transplantation and their risk of solid cancer is 14 times greater than the general population. Pediatric SOTRs are at significantly higher risk of cancer‐associated death. Improving patient survival among pediatric SOTRs puts them at risk of adult epithelial cancers associated with environmental carcinogenic exposures. Vaccination against oncogenic viruses and avoidance of excessive immunosuppression may reduce the risk of solid cancers following transplantation. Patient and family education regarding photoprotection is an essential component of skin cancer prevention. There is significant variability in cancer screening recommendations for SOTRs and general population approaches are typically not validated for transplant populations. An individualized approach to cancer screening should be developed based on estimated cancer risk, patient life expectancy, and screening test performance.

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“…Findings reported (85) in a single case of localized intramuscular PTLD in a 3-year-old child with multiorgan transplants included a hypoattenuating mass with variable enhancement at CT and a T1-hypointense and T2 iso-to slightly hyperintense mass with subtle peripheral contrast material enhancement at MRI. (86,87). Approximately 70% of the reported cases of cutaneous PTLD are diagnosed as T-cell monomorphic PTLD (87).…”

Section: Other Sites Of Ptld Involvementmentioning

confidence: 99%

Posttransplant Lymphoproliferative Disorder in Children: A 360-degree Perspective

Marie¹,

Navallas²,

Navarro³

et al. 2020

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Posttransplant lymphoproliferative disorder (PTLD) is the most common malignancy that can occur after organ transplant in children. PTLD arises because the patient's immune system has been suppressed to protect the graft and may fail to provide an adequate immune check for transformed malignant or premalignant lymphocytes. PTLD risk factors and pathogenesis are not completely understood; however, Epstein-Barr virus is identified in many patients with PTLD and may contribute to its evolution. PTLD is a clinical challenge because the biologic behavior and clinical manifestations are diverse, and there is no standardized treatment. Treatment options include reduction of immunosuppression therapy, chemotherapy, radiation therapy, and surgical resection of localized lesions, depending on factors including the type and extent of disease, whether the patient has positive test results for the Epstein-Barr virus, and patient comorbidities. A multidisciplinary approach is essential for the appropriate management of PTLD. Diagnostic imaging modalities such as radiography, US, CT, MRI, and PET are essential in diagnosis, assessment of therapeutic response, and monitoring of this heterogeneous disease entity. When imaging findings are suggestive of PTLD, prompt tissue biopsy to identify the PTLD subtype is essential for appropriate treatment. It is important to know the proper indications and limitations of different diagnostic imaging techniques in the management of PTLD. In addition, familiarity with the imaging features of PTLD and its mimics narrows the differential diagnosis and may facilitate decision making about patient treatment. ©

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Cutaneous involvement of polymorphic post‐transplant lymphoproliferative disorder in a child after liver transplantation

Cited by 5 publications

References 13 publications

Post-Transplant Lymphoproliferative Disorder: A Rare Case of CNS Involvement following Renal Transplant

Post-Transplant Lymphoproliferative Disorder: A Rare Case of CNS Involvement following Renal Transplant

Post‐transplant malignancies in pediatric organ transplant recipients

Posttransplant Lymphoproliferative Disorder in Children: A 360-degree Perspective

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