J Liver Cancer.  2019 Sep;19(2):165-170. 10.17998/jlc.19.2.165.

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

Affiliations
  • 1Department of Internal Medicine, Eunpyeong St. Mary's Hospital, Seoul, Korea.
  • 2Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea. yoonsk@catholic.ac.kr

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, ¹â¸F-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.

Keyword

Post-transplantation lymphoproliferative disease; Epstein-Barr virus; ¹⁸F-fluorodeoxyglucose positron emission tomography

MeSH Terms

Abscess*
Biopsy
Carcinoma, Hepatocellular
Hepacivirus
Herpesvirus 4, Human
Liver Transplantation
Liver*
Magnetic Resonance Imaging
Necrosis
Organ Transplantation
Positron-Emission Tomography
Prognosis
Seroconversion
Transplant Recipients
Transplants*

Figure

  • Figure 1. Radiologic findings of the necrotizing mass in the graft liver. (A) Contrast-enhanced abdominal magnetic resonance imaging (portal phase) detected a 7 cm irregular necrotizing mass with rim enhancement in the right hemi-liver mimicking a necrotizing abscess. (B) 18F-fluorodeoxyglucose positron emission tomography shows a single hypermetabolic malignant tumor with central hypometabolism.

  • Figure 2. Pathologic findings of the necrotizing mass in the graft liver (original magnification ×200). (A) H&E staining demonstrates a polymorphic post-transplantation lymphoproliferative disease with central necrosis. (B) Immunohistochemistry of CD20 shows positive cytoplasmic staining. (C) Immunohistochemistry of CD38 shows positive cytoplasmic staining. (D) In situ hybridization of Epstein-Barr-encoding region of RNA shows that most of the malignant cells are positive for the hybridization.

  • Figure 3. Follow-up imaging findings after treatment. (A) Contrast-enhanced abdominal computed tomography imaging of the graft liver shows a dramatic decrease in the post-transplantation lymphoproliferative disease (PTLD) lesion after treatment. (B) 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography imaging reveals no visible 18F-FDG uptake in the PTLD lesion after treatment.


Reference

1. Jiang Y, Villeneuve PJ, Fenton SS, Schaubel DE, Lilly L, Mao Y. Liver transplantation and subsequent risk of cancer: findings from a Canadian cohort study. Liver Transpl. 2008; 14:1588–1597.
2. Dierickx D, Cardinaels N. Posttransplant lymphoproliferative disorders following liver transplantation: where are we now? World J Gastroenterol. 2015; 21:11034–11043.
3. Hatton O, Martinez OM, Esquivel CO. Emerging therapeutic strategies for Epstein-Barr virus+ post-transplant lymphoproliferative disorder. Pediatr Transplant. 2012; 16:220–229.
4. Dierickx D, Tousseyn T, Gheysens O. How I treat posttransplant lymphoproliferative disorders. Blood. 2015; 126:2274–2283.
5. Lauro A, Arpinati M, Pinna AD. Managing the challenge of PTLD in liver and bowel transplant recipients. Br J Haematol. 2015; 169:157–172.
6. Petrara MR, Giunco S, Serraino D, Dolcetti R, De Rossi A. Posttransplant lymphoproliferative disorders: from epidemiology to pathogenesis-driven treatment. Cancer Lett. 2015; 369:37–44.
7. Kim H, Yi NJ, Lee J, Kim J, Moon MR, Jeong J, et al. Safety of reduced dose of mycophenolate mofetil combined with tacrolimus in living-donor liver transplantation. Clin Mol Hepatol. 2014; 20:291–299.
8. Jagadeesh D, Woda BA, Draper J, Evens AM. Post transplant lymphoproliferative disorders: risk, classification, and therapeutic recommendations. Curr Treat Options Oncol. 2012; 13:122–136.
9. Jain A, Nalesnik M, Reyes J, Pokharna R, Mazariegos G, Green M, et al. Posttransplant lymphoproliferative disorders in liver transplantation: a 20-year experience. Ann Surg. 2002; 236:429–436. ;discussion 436-437.
10. Leblond V, Choquet S. Lymphoproliferative disorders after liver transplantation. J Hepatol. 2004; 40:728–735.
11. Al-Mansour Z, Nelson BP, Evens AM. Post-transplant lymphoproliferative disease (PTLD): risk factors, diagnosis, and current treatment strategies. Curr Hematol Malig Rep. 2013; 8:173–183.
12. Kamdar KY, Rooney CM, Heslop HE. Posttransplant lymphoproliferative disease following liver transplantation. Curr Opin Organ Transplant. 2011; 16:274–280.
13. Yoon SO, Yu E, Cho YM, Suh C, Kim KM, Han DJ, et al. Posttransplant lymphoproliferative disorders: clinicopathological analysis of 43 cases in a single center, 1990-2009. Clin Transplant. 2012; 26:67–73.
14. Izadi M, Taheri S. Features, predictors and prognosis of lymphoproliferative disorders post-liver transplantation regarding disease presentation time: report from the PTLD. Int. survey. Ann Transplant. 2011; 16:39–47.
15. Nieters A, Kallinowski B, Brennan P, Ott M, Maynadié M, Benavente Y, et al. Hepatitis C and risk of lymphoma: results of the European multicenter case-control study EPILYMPH. Gastroenterology. 2006; 131:1879–1886.
16. Morton LM, Landgren O, Chatterjee N, Castenson D, Parsons R, Hoover RN, et al. Hepatitis C virus infection and risk of posttransplantation lymphoproliferative disorder among solid organ transplant recipients. Blood. 2007; 110:4599–4605.
17. Cazzola M. Introduction to a review series: the 2016 revision of the WHO classification of tumors of hematopoietic and lymphoid tissues. Blood. 2016; 127:2361–2364.
18. Parker A, Bowles K, Bradley JA, Emery V, Featherstone C, Gupte G, et al. Diagnosis of post-transplant lymphoproliferative disorder in solid organ transplant recipients - BCSH and BTS Guidelines. Br J Haematol. 2010; 149:675–692.
19. Martínez-Calle N, Alfonso A, Rifón J, Herrero I, Errasti P, Rábago G, et al. First-line use of rituximab correlates with increased overall survival in late post-transplant lymphoproliferative disorders: retrospective, single-centre study. Eur J Haematol. 2017; 98:38–43.
20. Evens AM, David KA, Helenowski I, Nelson B, Kaufman D, Kircher SM, et al. Multicenter analysis of 80 solid organ transplantation recipients with post-transplantation lymphoproliferative disease: outcomes and prognostic factors in the modern era. J Clin Oncol. 2010; 28:1038–1046.
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