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Posttransplantation Lymphoproliferative Disorder in Children: Clinical, Histopathologic, and Imaging Features¹

¹ From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, St Louis, MO 63110 (P.J.P., M.J.S.); the Department of Radiology/Nuclear Medicine, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Md (P.J.P.); and the Department of Pediatrics, Division of Hematology Oncology, Washington University School of Medicine, St Louis, Mo (R.J.H., M.K.). Received July 16, 1999; revision requested August 24; revision received September 14; accepted September 24. Address correspondence to M.J.S.

Posttransplantation lymphoproliferative disorder (PTLD) is a condition in patients who receive transplants in which chronic immunosuppression leads to an unregulated expansion of lymphoid cells; the condition ranges from hyperplasia to malignant lymphoid proliferation. Risk factors affecting the incidence of PTLD include allograft type, Epstein-Barr virus infection, and immunosuppression. In this article, we review the clinical, histopathologic, and imaging features of PTLD in children. Because PTLD can affect nearly any organ system, a wide variety of clinical manifestations is possible. The heterogeneous nature of the disease is also reflected on imaging studies. The goals of imaging in patients with PTLD are to detect disease, guide biopsy, and direct appropriate follow-up imaging rather than to establish a specific diagnosis. Because the clinical and imaging manifestations of PTLD are nonspecific and are not reliably predictive of histopathologic subtype, tissue biopsy is necessary for final diagnosis.

Index terms: Epstein-Barr virus, _**.2069² • Heart, transplantation, 51.45 • Kidney, transplantation, 81.45 • Liver, transplantation, 761.45 • Lung, transplantation, 60.45 • Lymphoma, CT, 99.12911, 99.12912, 99.834 • Lymphoma, in infants and children, 99.834 • Lymphoma, MR, 99.12941, 99.834 • State of the Art • Transplantation, 99.45 • Ultrasound (US), in infants and children, 99.1298, 99.834

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