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

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

MATERIALS AND METHODS: 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.

RESULTS: 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.

CONCLUSION: 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.