Posttransplant Lymphoproliferative Disorder

Epidemiology

Posttransplantation lymphoproliferative disorder (PTLD) is a lymphoproliferative disorder that occurs in patients who are chronically immunosuppressed after solid tissue organ transplantation. PTLD consists of a variety of disorders that include lymphoid hyperplasia and lymphoid neoplasia. The reported frequency range (1–10%) depends on the transplanted organ and may be related to specific immunosuppressive regimens. PTLD is believed to arise from unregulated B cell proliferation. There is a strong association between Epstein-Barr virus (EBV) and PTLD. A T cell variant of PTLD has been described that is not associated with EBV. The sites most commonly involved include Waldeyer’s ring, larynx, and lymph nodes.

Clinical Findings

The patients have all undergone solid tissue organ transplantation and typically present at least 3 months after transplant. The clinical symptoms for head and neck involvement are nonspecific and include an enlarging neck mass, otalgia, facial numbness or paresthesia, or a “mononucleosis-like syndrome.”