Spontaneous regression of central nervous system posttransplant lymphoproliferative disease

Abstract

Rationale: Primary central nervous system (CNS) posttransplant lymphoproliferative disease (PTLD) is a very rare entity. Patients may respond to reduction of immunosuppression or other therapies, but the prognosis is still pessimistic. Patient concerns: Herein, we report a 40-year-old female with a history of renal transplantation developed brain masses 4 years ago. Although brain biopsy was performed, PTLD was underdiagnosed then. No relevant treatment was administered. However, the lesions resolved spontaneously. After 4 years, new lesion appeared in a different brain region. Diagnoses: The history of renal transplantation raised the suspicion of PTLD. Reexamination of previous brain sections confirmed the diagnosis of polymorphic PTLD (P-PTLD). A second biopsy of the new lesion also demonstrated P-PTLD. Interventions: She was referred to hematology department to receive rituximab. Outcomes: After 4 rounds of treatment, the lesion resolved satisfactorily. Lessons: This case demonstrates the natural history of primary CNS P-PTLD. Although self-remission and recurrence is possible, aggressive measures should be taken to this condition.

Primary central nervous system post-transplantation lymphoproliferative disorder: A case report and systematic review of imaging findings

“…Leptomeningeal involvement of intracranial disease is common [56] . In immunocompromised patients, PCNS lymphoma may be more heterogeneous and centrally necrotic [1 , 50 , 57] . Spectroscopy can show high lipid and/or lactate peaks, increased choline/creatine ratio, and decreased N-acetylaspartate [1] .…”

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Extranodal involvement of posttransplant lymphoproliferative disorder detected on 18F‐fluorodeoxyglucose‐positron emission tomography/computed tomography

“…PTLD is a rare group of heterogeneous lymphoproliferative conditions that occur after solid organ or hematopoietic transplantation [1,2]. With allograft transplantation, the anatomic site of PTLD involvement usually depends on the type of transplant [3].…”