Mousa Abeer,  Fox Lauren,  Simmons Curtis

Final Pr. ID: Poster #: CR-058

We present a case of an 11-year-old male with history of pars planitis (intermediate uveitis) on monthly infliximab and weekly methotrexate. The patient developed diffuse lymphadenopathy, predominantly in the head and neck region, raising suspicion for malignancy. CT of the neck and chest demonstrated enlarged cervical, upper mediastinal , and bilateral axillary lymph nodes. PET/CT confirmed prominent FDG uptake in these lymph nodes. A lymph node biopsy of a parotid lymph node confirmed Epstein Barr virus-positive polymorphic lymphoproliferative disorder in the setting of immune deficiency/dysregulation. Follow up PET/CT 2 months later after discontinuation of immunosuppressive therapy demonstrated significant improvement in size and radiotracer uptake of the enlarged lymph nodes. However within this time frame, the patient’s uveitis worsened. The patient is being followed by ophthalmology to explore other localized treatment options including steroid eye drops and steroid implants.
The majority of described findings in the radiology literature encompasses lymphoproliferative disorders in the setting of transplant (post-transplant lymphoproliferative disorder (PTLD)) or primary immunodeficiency. However, there is little in the way of lymphoproliferative disorders associated with immunosuppressive therapy. Most cases reported in the literature involve methotrexate use in adults with rheumatoid arthritis. Prior to 2022, this entity held a WHO classification entitled “other iatrogenic immunodeficiency-associated lymphoproliferative disorders (OII-LPD)”. Following a 2022 WHO reclassification, both PTLD and OII-LPD are encompassed under the classification of “lymphoid proliferations and lymphomas associated with immune deficiency and dysregulation". Further research on imaging of OII-LPD would add to the existing literature and increase awareness of such an entity in the setting of immunosuppressive therapy. Read More

Authors:  Mousa Abeer , Fox Lauren , Simmons Curtis

Keywords:  Lymphoproliferative, PTLD, Lymphadenopathy

Kirihetti Liyanage Neelika,  Kumbla Surekha

Final Pr. ID: Poster #: EDU-001

Post-transplant lymphoproliferative disorder (PTLD) is an important cause of morbidity and mortality which affects transplant recipients of solid organs and allogenic bone marrow transplants. Paediatric recipients of organs that require high levels of immunosuppression are the most susceptible population. Incidence and the frequency of PTLD in paediatric age group is consistently higher than it is in adults. There is insufficient recent literature on imaging features of PTLD in the paediatric age group.
Our purpose is to illustrate multi-modality imaging characteristics of PTLD affecting different organs and systems in a cohort of paediatric patients with biopsy proven PTLD. Read More

Authors:  Kirihetti Liyanage Neelika , Kumbla Surekha

Keywords:  PTLD, Transplant, Lymphadenopathy

Maddocks Alexis,  Fenlon Edward,  Chen Susie,  Ruzal-shapiro Carrie,  Jaramillo Diego

Final Pr. ID: Poster #: EDU-083

Post-Transplant Lymphoproliferative Disease (PTLD) is a polyclonal and monoclonal lymphoid proliferation which occurs in 1-20% of solid organ transplant recipients. It is most common in multivisceral organ transplants followed by small bowel transplants, heart and lung transplants and less commonly in liver and kidney transplants. PTLD has a bimodal distribution of occurrence with the largest peak occurring within 1 year after transplantation and a second peak at approximately 4-5 years after transplantation. The Epstein Barr virus (EBV) is associated in 50-70% of cases. EBV seronegativity in the recipient at the time of transplant predicts a 2-4 times increased risk of PTLD especially if they receive a donor organ which is positive for EBV. This may explain the higher incidence in the pediatric population who tend to be seronegative for EBV. The World Health Organization (WHO) identifies four pathologic categories of PTLD: early lesions, polymorphic type, monomorphic type and classic Hodgkins lymphoma. The majority of PTLD cases are caused by B-lymphocyte proliferation in a T-cell depleted environment in the setting of immunosuppression. However, there is a subset of cases that are caused by T-cell or natural killer cells as well as cases that occur in the setting of negative EBV. Multiple clones of proliferating B-cells can be seen in a single patient. 2/3 of cases have diffuse expression of CD20 which is an important target for therapy.

PTLD may be focal or diffuse and can manifest in a variety of different organ systems or even in the allograft itself. There is a higher percentage of extranodal disease in PTLD as compared to immunocompetent patients with lymphoma. The GI tract and liver are most commonly involved. Isolated lymph node involvement in comparison is less common in patients with PTLD. Central nervous system (CNS) involvement is relatively rare in PTLD.

This educational exhibit will provide a pictorial review of PTLD and illustrates cases from one of the busiest transplant centers in North America to highlight the major imaging findings as well as complications seen on imaging of this disease. Extranodal and nodal disease will be demonstrated on multiple modalities as well as complications of this disease including intussusception and biliary obstruction. CNS disease will also be shown. The clinical manifestations, imaging characteristics, prognosis and treatment will be discussed and depicted. Read More

Authors:  Maddocks Alexis , Fenlon Edward , Chen Susie , Ruzal-shapiro Carrie , Jaramillo Diego

Keywords:  PTLD

Wu Markus,  Sharma Priya,  Rajderkar Dhanashree

Final Pr. ID: Poster #: EDU-036

In this education exhibit we will review a variety of presentations of posttransplant lymphoproliferative disorder (PTLD) and review the approach to imaging these patients. We will include cases that are atypical and discuss the pitfalls in imaging this population. We will provide imaging guidelines after a review of the current literature. Read More

Authors:  Wu Markus , Sharma Priya , Rajderkar Dhanashree

Keywords:  PTLD, Transplantation, Pitfalls

Samreen Naziya,  Sharma Priya,  Tuna Ibrahim,  Rajderkar Dhanashree

Final Pr. ID: Poster #: EDU-113

1. To establish the role of imaging in diagnosing the atypical/unexpected cases of post transplant lymphoproliferative disorder in Pediatric population.
2. To review the role of Radiology Imaging in staging, treatment monitoring and predicting the prognosis in Pediatric PTLD. Read More

Authors:  Samreen Naziya , Sharma Priya , Tuna Ibrahim , Rajderkar Dhanashree

Keywords:  Transplant, Lymphoproliferative, PTLD, Unexpected, Management of PTLD