J Korean Soc Transplant.  2013 Jun;27(2):67-71.

A Brain Tumor from a Posttransplant Lymphoproliferative Disorder in a Kidney Transplant Recipient

• Paek JH
• Kim YR
• Jang MH
• Hwang EA
• Han SY
• Park SB

Abstract

Posttransplant lymphoproliferative disorder (PTLD) is a life-threatening complication from organ transplantation. PTLD usually manifests as a mass in the lymph node or an extranodal mass in solid organs, such as the liver, transplanted kidney, tonsil, bone marrow, or spleen. PTLD rarely involves the central nervous system (CNS); however, here we report a case of PTLD that manifested as a brain tumor after kidney transplantation. A 52-year-old man who started peritoneal dialysis due to autosomal dominant polycystic kidney disease, underwent kidney transplantation 4 years ago. After kidney transplantation, he took tacrolimus, mycophenolate mofetil, and steroids. He was admitted to our hospital, complaining of a severe headache. Brain magnetic resonance imaging showed a multifocal, irregular, and round enhancing mass in the left basal ganglia. He underwent a needle biopsy for the enhancing mass and the pathological diagnosis was diffuse large B cell lymphoma. After this mass was confirmed as PTLD by histologic diagnosis, the patient had a reduction in his immunosuppression regimen (including a change from tacrolimus to sirolimus) and was treated with chemotherapy for PTLD. After 20 days, the patient expired from sepsis. PTLD involving the CNS is a rare and serious complication associated with solid organ transplantation. PTLD should be included in the differential diagnosis of brain tumors in recipients of solid organ transplants.

Keyword

Posttransplant lymphoproliferative disorder; Kidney transplantation; Brain neoplasms

MeSH Terms

Basal Ganglia
Biopsy, Needle
Bone Marrow
Brain
Brain Neoplasms
Central Nervous System
Diagnosis, Differential
Headache
Humans
Immunosuppression
Kidney
Kidney Transplantation
Liver
Lymph Nodes
Lymphoma, B-Cell
Lymphoproliferative Disorders
Magnetic Resonance Imaging
Mycophenolic Acid
Organ Transplantation
Palatine Tonsil
Peritoneal Dialysis
Polycystic Kidney, Autosomal Dominant
Sepsis
Spleen
Steroids
Tacrolimus
Transplants
Mycophenolic Acid
Steroids
Tacrolimus

Figure

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  Fig. 1. Brain computed tomography shows brain tumor with adjacent edema and mass effect in left cerebral hemisphere.

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  Fig. 2. Brain magnetic resonance imaging shows brain tumor involved in left thalamus, basal ganglia, periventricular white matter, midbrain, pons, and middle cerebellar peduncle.

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  Fig. 3. The pathological examination showed uniform large lymphocytes (A, HE stain,×400; B, PAS stain, ×400). Immunohistochemistry stain of (C) CD20, (D) CD79a was positive, (E) Ki-67 proliferation was about 30% and (F) glial fibrillary acidic protein was negative.

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