Posttransplantation lymphoproliferative disease: proposed imaging classification

Area of Science:

• Oncology
• Transplantation Medicine
• Virology

Background:

• Posttransplantation lymphoproliferative disease (PTLD) is the second most frequent malignancy in adult transplant recipients.
• Most PTLD cases are associated with Epstein-Barr virus (EBV) reactivation due to immunosuppression.
• PTLD presentation varies histologically from hyperplasia to lymphoma, requiring tissue sampling for subtyping.

Purpose of the Study:

• To review the role of imaging in the diagnosis and management of PTLD.
• To highlight the varied imaging appearances of PTLD.
• To emphasize the importance of tissue sampling for PTLD subtyping and treatment.

Main Methods:

• Review of existing literature on PTLD imaging.
• Analysis of imaging characteristics across different PTLD subtypes and locations.
• Correlation of imaging findings with histopathology and treatment outcomes.

Main Results:

• PTLD incidence varies by allograft type and immunosuppression.
• PTLD exhibits bimodal occurrence: early post-transplant and a later peak at 4-5 years.
• Imaging findings are diverse, including nodal and extranodal involvement (GI tract, CNS, solid organs).
• Extranodal lesions can be solitary or multiple, potentially causing organ obstruction.

Conclusions:

• Imaging is vital for detecting PTLD, guiding biopsies, and monitoring treatment response.
• Characteristic imaging findings warrant tissue sampling for definitive diagnosis and subtyping.
• Treatment strategies are tailored to PTLD subtype and may involve reduced immunosuppression, chemotherapy, radiation, or surgery.