Posttransplantation Lymphoproliferative Disorder of the Head and Neck: Imaging Features in Seven Adults1
Laurie A. Loevner, MD,
Ronit L. Karpati, MD,
Priya Kumar, MD,
David M. Yousem, MD,
Wendy Hsu, MD and
Kathleen T. Montone, MD
1 From the Departments of Radiology (L.A.L., D.M.Y.) and Pathology (K.T.M.), and the University of Pennsylvania School of Medicine (R.L.K., P.K., W.H.), University of Pennsylvania Medical Center, 3400 Spruce St, Philadelphia, PA 19104. From the 1998 RSNA scientific assembly. Received August 30, 1999; revision requested October 8; final revision received January 4, 2000; accepted January 12. L.A.L. supported by an RSNA Research and Education Foundation Scholar grant. W.H. supported by the RSNA Research and Education Foundation Medical Student/Scholar Assistant program. Address correspondence to L.A.L. (e-mail: loevner@oasis.rad.upenn.edu).
View larger version (158K):
[in a new window]
|
Figure 1a. Patient 3. Contrast-enhanced transverse CT scans obtained in a 53-year-old woman after bilateral lung transplantation. PTLD was proved with CT-guided biopsy results. (a) Scan obtained at the level of the nasopharynx demonstrates a low-attenuating mass (arrows) at the level of the fossa of Rosenmüller and lateral nasopharyngeal wall on the left. An abscess was suspected. (b) Scan obtained 2 cm inferior to a demonstrates extension of the mass to the oropharynx and tonsil. The mass is characterized by a central hypoattenuating area consistent with necrosis (arrow). Circumferentially, there is a thick rind of solid lymphoid tissue (arrowheads). The mass at this level is predominantly submucosal within the parapharyngeal space. (c) Scan obtained at the level of the upper thorax demonstrates a small mass (arrow) in the superior mediastinum.
|
|
View larger version (154K):
[in a new window]
|
Figure 1b. Patient 3. Contrast-enhanced transverse CT scans obtained in a 53-year-old woman after bilateral lung transplantation. PTLD was proved with CT-guided biopsy results. (a) Scan obtained at the level of the nasopharynx demonstrates a low-attenuating mass (arrows) at the level of the fossa of Rosenmüller and lateral nasopharyngeal wall on the left. An abscess was suspected. (b) Scan obtained 2 cm inferior to a demonstrates extension of the mass to the oropharynx and tonsil. The mass is characterized by a central hypoattenuating area consistent with necrosis (arrow). Circumferentially, there is a thick rind of solid lymphoid tissue (arrowheads). The mass at this level is predominantly submucosal within the parapharyngeal space. (c) Scan obtained at the level of the upper thorax demonstrates a small mass (arrow) in the superior mediastinum.
|
|
View larger version (119K):
[in a new window]
|
Figure 1c. Patient 3. Contrast-enhanced transverse CT scans obtained in a 53-year-old woman after bilateral lung transplantation. PTLD was proved with CT-guided biopsy results. (a) Scan obtained at the level of the nasopharynx demonstrates a low-attenuating mass (arrows) at the level of the fossa of Rosenmüller and lateral nasopharyngeal wall on the left. An abscess was suspected. (b) Scan obtained 2 cm inferior to a demonstrates extension of the mass to the oropharynx and tonsil. The mass is characterized by a central hypoattenuating area consistent with necrosis (arrow). Circumferentially, there is a thick rind of solid lymphoid tissue (arrowheads). The mass at this level is predominantly submucosal within the parapharyngeal space. (c) Scan obtained at the level of the upper thorax demonstrates a small mass (arrow) in the superior mediastinum.
|
|
View larger version (142K):
[in a new window]
|
Figure 2a. Patient 5. Nonenhanced transverse CT scans obtained in a 21-year-old man with acute onset of PTLD 4 months after kidney and pancreas transplantation. Nonenhanced CT was performed owing to renal failure due to acute rejection of the transplanted kidney. (a) Scan shows large masses involving the bilateral tonsils of the Waldeyer ring at the level of the oropharynx, which meet at the midline (arrowhead). These were sampled at biopsy, and PTLD was proved at histopathologic examination. (b) Scan obtained more inferiorly demonstrates bilateral lymph nodes (arrows) that were suspected of being involved with PTLD; however, the nodal diameters remained within normal size criteria.
|
|
View larger version (140K):
[in a new window]
|
Figure 2b. Patient 5. Nonenhanced transverse CT scans obtained in a 21-year-old man with acute onset of PTLD 4 months after kidney and pancreas transplantation. Nonenhanced CT was performed owing to renal failure due to acute rejection of the transplanted kidney. (a) Scan shows large masses involving the bilateral tonsils of the Waldeyer ring at the level of the oropharynx, which meet at the midline (arrowhead). These were sampled at biopsy, and PTLD was proved at histopathologic examination. (b) Scan obtained more inferiorly demonstrates bilateral lymph nodes (arrows) that were suspected of being involved with PTLD; however, the nodal diameters remained within normal size criteria.
|
|
View larger version (166K):
[in a new window]
|
Figure 3a. Patient 1. Spin-echo MR images in a 44-year-old man in whom PTLD was diagnosed 23 months after liver transplantation for chronic active hepatitis. (a) Nonenhanced sagittal T1-weighted image (400/11, two signals acquired) demonstrates a circumscribed mass (arrows) centered in the region of the left nasopharynx, with central signal intensity similar to that of cerebrospinal fluid. The peripheral area has a rind of thick lymphoid tissue (arrowheads) that is isointense to muscle. (b) Contrast-enhanced transverse T1-weighted image (600/17, one signal acquired) also demonstrates the mass (arrows), which is predominantly submucosal, in the left nasopharynx. This mass was initially interpreted as being an abscess. Biopsy results demonstrated a necrotic mass consistent with polymorphic B-cell lymphoma. PTLD was also histopathologically demonstrated in the gastrointestinal tract at rectosigmoid biopsy.
|
|
View larger version (162K):
[in a new window]
|
Figure 3b. Patient 1. Spin-echo MR images in a 44-year-old man in whom PTLD was diagnosed 23 months after liver transplantation for chronic active hepatitis. (a) Nonenhanced sagittal T1-weighted image (400/11, two signals acquired) demonstrates a circumscribed mass (arrows) centered in the region of the left nasopharynx, with central signal intensity similar to that of cerebrospinal fluid. The peripheral area has a rind of thick lymphoid tissue (arrowheads) that is isointense to muscle. (b) Contrast-enhanced transverse T1-weighted image (600/17, one signal acquired) also demonstrates the mass (arrows), which is predominantly submucosal, in the left nasopharynx. This mass was initially interpreted as being an abscess. Biopsy results demonstrated a necrotic mass consistent with polymorphic B-cell lymphoma. PTLD was also histopathologically demonstrated in the gastrointestinal tract at rectosigmoid biopsy.
|
|
View larger version (132K):
[in a new window]
|
Figure 4a. Patient 4. Nonenhanced transverse CT scans in a 52-year-old man who developed PTLD of the neck 9 years after undergoing heart transplantation. Intravenous contrast material was not administered owing to renal insufficiency. (a) Scan obtained at the level of the thyroid cartilage demonstrates a 7-cm circumscribed nodal mass in the right side of the neck with a small area of questionably low attenuation (arrow). Polymorphic B-cell lymphoma was diagnosed at biopsy, and necrosis was confirmed at histopathologic examination. (b) Follow-up scan obtained 7 months later shows complete resolution of the mass after treatment with decreased immunosuppressive therapy followed by chemotherapy and radiation therapy.
|
|
View larger version (137K):
[in a new window]
|
Figure 4b. Patient 4. Nonenhanced transverse CT scans in a 52-year-old man who developed PTLD of the neck 9 years after undergoing heart transplantation. Intravenous contrast material was not administered owing to renal insufficiency. (a) Scan obtained at the level of the thyroid cartilage demonstrates a 7-cm circumscribed nodal mass in the right side of the neck with a small area of questionably low attenuation (arrow). Polymorphic B-cell lymphoma was diagnosed at biopsy, and necrosis was confirmed at histopathologic examination. (b) Follow-up scan obtained 7 months later shows complete resolution of the mass after treatment with decreased immunosuppressive therapy followed by chemotherapy and radiation therapy.
|
|
Copyright © 2000 by the Radiological Society of North America.
