Posttransplantation lymphoproliferative disorder of the abdomen: CT evaluation in 51 patients

To study the appearance and distribution of posttransplantation lymphoproliferative disorder (PTLD) at abdominal computed tomography (CT).

The authors retrospectively analyzed pretreatment abdominal CT scans in 51 patients (mean age, 36 years) with PTLD after solid organ transplantation. All diagnoses were proved at either abdominal (n = 26) or extraabdominal (n = 25) pathologic examination. Presence or absence of abdominal involvement, appearance and distribution of disease, and association with abdominal symptoms were all analyzed.

CT scans were abnormal in 36 of the 51 patients (71%). Fifteen patients (29%) had no CT, clinical, or pathologic evidence of abdominal involvement. Of the 36 patients with abdominal PTLD at CT, 22% had lymph node enlargement, 28% splenic involvement, and 81% extranodal or extrasplenic involvement. Extranodal abdominal sites included liver (53%), small bowel (25%), kidney (17%), mesentery (14%), adrenal gland (8%), abdominal wall (8%), colon (6%), stomach (3%), and gallbladder (3%). Frequency of abdominal involvement was greater for heart and liver transplant recipients (94%) than for lung and kidney transplant recipients (58%) (P < .01). Seventeen of 36 patients (47%) with abdominal PTLD had no evidence of extraabdominal disease.

Extranodal involvement is more common than splenic or nodal involvement in patients with abdominal PTLD. The presence of such findings in a patient after transplantation strongly suggests the diagnosis of PTLD and warrants aggressive evaluation.