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

• Sung PS
• Lee J
• Lee J
• Nam HC
• Bae SH
• Yoon SK

• KMID: 2463619
• DOI: http://doi.org/10.17998/jlc.19.2.165

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

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  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.

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  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.

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