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Zhu F, Li Q, Liu T, Xiao Y, Pan H, Liu X, Wu G, Zhang L. Primary central nervous system lymphoma after heart transplantation: A case report and literature review. Medicine (Baltimore) 2020; 99:e21844. [PMID: 32871907 PMCID: PMC7458240 DOI: 10.1097/md.0000000000021844] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Revised: 06/16/2020] [Accepted: 07/21/2020] [Indexed: 11/26/2022] Open
Abstract
RATIONALE The heart transplantation is the most important treatment for patients with end-stage severe heart disease who failed to conventional therapy. Post-transplant lymphoproliferative disorder is the second most common malignancy in heart transplant recipients. However, primary central nervous system lymphoma (PCNSL) after heart transplantation is an extremely rare condition. PATIENTS CONCERNS This report described a 53-year-old male who was diagnosed as PCNSL 17 months after heart transplantation. DIAGNOSES The patient was admitted to the local hospital presenting with dizziness, headache, and reduced left-sided power and sensation for 1 week. He had a medical history of heart transplantation because of the dilated cardiomyopathy 17 months ago and had a 17-month history of immunosuppressive therapy with tacrolimus. A computed tomography scan of the brain revealed a bulky mass in the right temporal lobe. The emergency intracranial mass resection and cerebral decompression were performed in our hospital. The histopathology of the brain lesions showed diffuse large B-cell lymphoma. A further FDG positron emission tomography-computed tomography scan of the whole body showed no significantly increased metabolic activity in other regions. The final diagnosis of this patient was PCNSL after heart transplantation. INTERVENTIONS Given the poor health condition, with the patient's consent, the whole brain radiotherapy was performed with supportive care. OUTCOMES The disease deteriorated rapidly during the period of receiving radiotherapy, and he died within 2 months from the diagnosis. LESSONS PCNSL after heart transplantation is an extremely rare phenomenon with extremely poor prognosis. We should pay close attention to the heart recipients, especially when the patients present with neurological symptoms and signs. The available treatment options for PCNS-post-transplant lymphoproliferative disorder include the reduction of immunosuppressive drugs, immune-chemotherapy, operation, radiotherapy. However, individual treatments for heart transplant recipients with PCNSL should be based on the performance status and tolerance to treatment, combined with the doctor's experience and supportive care.
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Affiliation(s)
| | | | | | | | - Huaxiong Pan
- Department of Pathology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Iu LP, Yeung JC, Loong F, Chiang AK. Successful treatment of intraocular post-transplant lymphoproliferative disorder with intravenous rituximab. Pediatr Blood Cancer 2015; 62:169-72. [PMID: 25174958 DOI: 10.1002/pbc.25223] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Accepted: 07/23/2014] [Indexed: 11/09/2022]
Abstract
We reported a rare case of intraocular post-transplant lymphoproliferative disorder (PTLD) arising in a 3-year-old liver transplant recipient who had a prior history of systemic PTLD. The first PTLD entered remission after treatment with intravenous rituximab and withdrawal of immunosuppressants. One year after remission, she presented with granulomatous uveitis and iris nodules in the right eye. Iris biopsy confirmed recurrence of intraocular PTLD, which resolved completely after a second course of intravenous rituximab.
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Affiliation(s)
- Lawrence P Iu
- Department of Ophthalmology, The University of Hong Kong, Queen Mary Hospital, Hong Kong
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3
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Moslehi R, Schymura MJ, Nayak S, Coles FB. Ocular adnexal non-Hodgkin's lymphoma: a review of epidemiology and risk factors. EXPERT REVIEW OF OPHTHALMOLOGY 2014; 6:181-193. [PMID: 23976898 DOI: 10.1586/eop.11.15] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Ocular adnexal non-Hodgkin's lymphoma (NHL), the most common form of ophthalmic NHL, has a unique incidence pattern showing a steady and rapid increase in the past few decades, nearly equal rates among both genders, and predominance among Asians/Pacific Islanders. No major cause for ocular adnexal NHL has been identified, although infectious agents, immune disorders and genetic/epigenetic factors have all been implicated in its etiology. Identifying putative risk factors and biologic mechanisms leading to carcinogenesis in ocular adnexal NHL may enable implementation of effective preventive and/or therapeutic approaches for this malignancy. This article summarizes current knowledge on epidemiology of ocular adnexal NHL and the role of various potential risk factors in its etiology.
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Affiliation(s)
- Roxana Moslehi
- Department of Epidemiology and Biostatistics, School of Public Health, State University of New York at Albany, NY, USA ; Cancer Research Center, State University of New York at Albany, NY, USA
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Sagoo MS, Mehta H, Swampillai AJ, Cohen VML, Amin SZ, Plowman PN, Lightman S. Primary intraocular lymphoma. Surv Ophthalmol 2013; 59:503-16. [PMID: 24560125 DOI: 10.1016/j.survophthal.2013.12.001] [Citation(s) in RCA: 145] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2012] [Revised: 12/10/2013] [Accepted: 12/10/2013] [Indexed: 01/25/2023]
Abstract
Primary intraocular lymphoma (PIOL) is an ocular malignancy that is a subset of primary central system lymphoma (PCNSL). Approximately one-third of PIOL patients will have concurrent PCNSL at presentation, and 42-92% will develop PCNSL within a mean of 8-29 months. Although rare, the incidence has been rising in both immunocompromised and immunocompetent populations. The majority of PIOL is diffuse large B-cell lymphoma, though rare T-cell variants are described. Recently, PIOL has been classified by main site of involvement in the eye, with vitreoretinal lymphoma as the most common type of ocular lymphoma related to PCNSL. Diagnosis remains challenging for ophthalmologists and pathologists. PIOL can masquerade as noninfectious or infectious uveitis, white dot syndromes, or occasionally as other neoplasms such as metastatic cancers. Laboratory diagnosis by cytology has been much aided by the use of immunocytochemistry, flow cytometry, biochemical finding of interleukin changes (IL10:IL6 ratio > 1), and cellular microdissection with polymerase chain reaction amplification for clonality. Use of several tests improves the diagnostic yield. Approaches to treatment have centered on systemic methotrexate-based chemotherapy, often with cytarabine (Ara-C) and radiotherapy. Use of intravitreal chemotherapy with methotrexate (0.4 mg/0.1 mL) is promising in controlling ocular disease, and intravitreal rituximab (anti-CD20 monoclonal antibody) has also been tried. Despite these advances, prognosis remains poor.
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Affiliation(s)
- Mandeep S Sagoo
- UCL Institute of Ophthalmology, London, UK; Moorfields Eye Hospital, London, UK; Department of Ophthalmology, St Bartholomew's Hospital, London, UK.
| | | | | | - Victoria M L Cohen
- Moorfields Eye Hospital, London, UK; Department of Ophthalmology, St Bartholomew's Hospital, London, UK
| | | | | | - Sue Lightman
- UCL Institute of Ophthalmology, London, UK; Moorfields Eye Hospital, London, UK
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Epstein-Barr virus-related optic neuritis as a precursor to the development of posttransplant lymphoproliferative disease. J Pediatr Gastroenterol Nutr 2009; 49:243-5. [PMID: 19252447 DOI: 10.1097/mpg.0b013e31817e6f95] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
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Traum AZ, Rodig NM, Pilichowska ME, Somers MJG. Central nervous system lymphoproliferative disorder in pediatric kidney transplant recipients. Pediatr Transplant 2006; 10:505-12. [PMID: 16712612 DOI: 10.1111/j.1399-3046.2006.00497.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Post-transplant lymphoproliferative disorder (PTLD) is a complication of transplantation resulting from impaired immune surveillance because of pharmacologic immunosuppression. We present two cases of central nervous system (CNS) PTLD in children on calcineurin-inhibitor free immunosuppression with dramatically different presentations and outcomes. One patient had brain and spinal cord lymphoma with a rapid and fatal course. The other patient had brain and ocular PTLD that responded to multimodal therapy with reduction of immunosuppression, high-dose steroids, and rituximab given in a dose-escalation protocol. This protocol may have enhanced the penetration of rituximab into the CNS. We review the literature on CNS and ocular PTLD and elaborate on the treatments available for both diseases.
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Affiliation(s)
- Avram Z Traum
- Division of Nephrology, Children's Hospital, Boston, MA 02115, USA.
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Bradfield YS, Kushner BJ, Gangnon RE. Ocular complications after organ and bone marrow transplantation in children. J AAPOS 2005; 9:426-32. [PMID: 16213391 DOI: 10.1016/j.jaapos.2005.06.002] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2005] [Revised: 06/20/2005] [Accepted: 06/20/2005] [Indexed: 11/26/2022]
Abstract
BACKGROUND Organ and bone marrow transplantation commonly are performed in children. Ocular complications usually are described as secondary to post-transplantation medications. The complication rate is unknown. METHODS A retrospective chart review was performed of 93 children who were younger than 18 years of age and had transplantation surgery from 1989 to 2004. The rate and type of ocular complications, including those requiring ocular surgery, were analyzed. Medications and visual loss associated with adverse effects also were studied. RESULTS Of the 93 patients, 74 patients met the entry criteria. Sixty-one patients had at least 1 year of follow-up, and the longest follow-up duration was 14 years. The 1-year post-transplantation complication rate was 16.0% (95% confidence interval 6.8-24.4%). Adverse effects included cytomegalovirus (CMV) retinitis, cataract, graft-versus-host disease, lymphoproliferative disorder, persistent strabismus, and transient visual loss. Four patients underwent eye surgery, including lensectomy for cataract, tarsorrhaphy for corneal ulcer, and iris biopsy. They had surgery 0.9 to 4.7 years after transplantation. Most patients were taking prednisone and cyclosporine when their complication was diagnosed. One patient's visual acuity deteriorated to no light perception in one eye and 20/250 in the other eye secondary to CMV retinitis. Most patients had a final visual acuity > or =20/40. CONCLUSION Transplantation surgery in children produces a significant risk of ocular impairment. The 1-year complication rate was 16.0%. Eye surgery may be required within the first few years after transplantation. Although most patients maintained a final visual acuity of 20/40 or better, one patient became bilaterally legally blind.
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Affiliation(s)
- Yasmin S Bradfield
- Department of Ophthalmology and Visual Sciences, University of Wisconsin, 2870 University Avenue, Madison, WI 53705, USA.
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Cheung D, Prabhakaran V, Brown L, Stitson RNM, Sampath R. Bilateral lacrimal gland enlargement due to post-transplant lymphoproliferative disorder. Eye (Lond) 2005; 20:972-4. [PMID: 16167077 DOI: 10.1038/sj.eye.6702084] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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Park S, Abad S, Tulliez M, Monnet D, Merlat A, Gyan E, Bouscary D, Dreyfus F, Grimaldi D, Dhote R, Rollot F, Kelaïdi C, Nazal EM, Brézin AP, Blanche P. Pseudouveitis: a clue to the diagnosis of primary central nervous system lymphoma in immunocompetent patients. Medicine (Baltimore) 2004; 83:223-232. [PMID: 15232310 DOI: 10.1097/01.md.0000134850.35118.46] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Primary oculocerebral non-Hodgkin lymphoma (NHL) of the immunocompetent patient is associated with significant morbidity and mortality, but early diagnosis and follow-up may improve prognosis. The eye, anatomically and embryologically part of the central nervous system (CNS), can be the primary site of the lymphomatous process. In patients with symptoms of atypical uveitis, vitrectomy can be of great help for early diagnosis of primary central nervous system lymphoma. We retrospectively reviewed the diagnostic features, treatment, and evolution of 10 patients with primary central nervous system lymphoma who presented with symptoms of pseudouveitis. The patients complained of chronic vitreal opacities, increasing with time. These symptoms contrasted with the absence of the usual signs of inflammation of the anterior segment or of the retina, which characterize true uveitis. Vitrectomy was proposed after lumbar puncture and cerebral magnetic resonance imaging. Six vitrectomies were carried out, 3 patients had a stereotaxic biopsy, and 1 patient had a cardiac biopsy. A pathologic diagnosis of large B-cell lymphoma was made on vitrectomy specimens in 100% of the patients who had this procedure. The mean time from onset of ocular symptoms to diagnosis was 24 months. This series was characterized by a rare systemic dissemination of the NHL (negative in 80%), a strong preponderance of B-cell NHL, and the absence of association with Epstein-Barr virus (EBV) among these immunocompetent patients. To our knowledge, this series includes the only reported case of oculocardiac lymphoma. Meningeal dissemination appeared to be associated with a poor prognosis. Neurologic complications of treatment combining radiotherapy and methotrexate were significant among patients older than 60 years of age. The current study suggests that primary central nervous system lymphoma should be suspected in patients with pseudouveitis, and that the diagnosis can be established quickly and without side effects by vitrectomy. These patients should be followed carefully in order to detect meningeal dissemination.
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Affiliation(s)
- Sophie Park
- From Services de médecine interne (SP, SA, DG, RD, FR, CK, EMN, PB), Service d'ophtalmologie (DM, APB), Service d'anatomopathologie (MT), and Service d'hématologie (SP, AM, EG, DB, FD), Hôpital Cochin, Paris, France
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Douglas RS, Goldstein SM, Katowitz JA, Gausas RE, Ibarra MS, Tsai D, Sharma A, Nichols C. Orbital presentation of posttransplantation lymphoproliferative disorder: a small case series. Ophthalmology 2002; 109:2351-5. [PMID: 12466183 DOI: 10.1016/s0161-6420(02)01299-x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To describe a small series of patients with orbital presentation of posttransplantation lymphoproliferative disorder (PTLD). DESIGN Retrospective, interventional case series. PARTICIPANTS Three patients with orbital presentation of histologically diagnosed PTLD. METHODS Review of medical records. MAIN OUTCOME MEASURES Measured parameters included vision, proptosis, and tumor extent. RESULTS Three cases of orbital PTLD are described. In two of the cases, the tumor initially demonstrated orbital signs and symptoms, whereas in the third case, orbital and systemic signs were synchronous. Two of three patients had disseminated disease discovered at the time of presentation. One adult patient had synchronous presentation of PTLD in the orbit and prostate. One pediatric patient had tumor dissemination to the liver at the time of presentation. The PTLD tumors were classified histologically as diffuse large cell lymphoma of monomorphic or immunoblastic type in all three cases. Treatment included local irradiation, decreased immunosuppression, and antilymphocyte monoclonal antibodies. CONCLUSIONS Orbital presentation is a rare manifestation of PTLD. However, ophthalmologists must consider this diagnosis carefully in organ transplant recipients with subtle orbital signs and symptoms at presentation. Early detection may alter prognosis. In each case presented, the diagnosis was established via lesion biopsy and subsequent histologic or flow cytometric evaluation, or both.
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Affiliation(s)
- Raymond S Douglas
- Department of Ophthalmology, University of Pennsylvania, Philadelphia 19104, USA.
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Demols PF, Cochaux PM, Velu T, Caspers-Velu L. Chorioretinal post-transplant lymphoproliferative disorder induced by the Epstein-Barr virus. Br J Ophthalmol 2001; 85:93-5. [PMID: 11133721 PMCID: PMC1723697 DOI: 10.1136/bjo.85.1.93] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND The Epstein-Barr virus (EBV) is responsible for the lymphoproliferative disorders observed in transplanted patients. METHODS The case history is described of a 59 year old man with a chorioretinal lesion who had received a single lung transplant and was on immunosuppressive treatment. Immunoglobulin gene rearrangement and EBV detection by polymerase chain reaction (PCR) with semiquantification were used on the vitreous material. RESULTS A proliferation of B lymphocytes with a monoclonal subpopulation was found by PCR on the vitreous sample. The large amounts of EBV genomes found in the vitreous suggest that EBV was the cause of the lymphoproliferation. Healing of the lesion was achieved by a decrease in immunosuppressive treatment and the use of nucleotide analogues. CONCLUSION The diagnosis of ocular post-transplant lymphoproliferative disorder (PTLD) can be made by PCR on vitreous material. Early diagnosis and treatment can lead to regression of limited monoclonal lesions.
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Affiliation(s)
- P F Demols
- Department of Ophthalmology, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium.
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Abstract
Solid-organ transplantation is a therapeutic option for many human diseases. Infections are a major complication of solid-organ transplantation. All candidates should undergo a thorough infectious-disease screening prior to transplantation. There are three time frames, influenced by surgical factors, the level of immunosuppression, and environmental exposures, during which infections of specific types most frequently occur posttransplantation. Most infections during the first month are related to surgical complications. Opportunistic infections typically occur from the second to the sixth month. During the late posttransplant period (beyond 6 months), transplantation recipients suffer from the same infections seen in the general community. Opportunistic bacterial infections seen in transplant recipients include those caused by Legionella spp., Nocardia spp., Salmonella spp., and Listeria monocytogenes. Cytomegalovirus is the most common cause of viral infections. Herpes simplex virus, varicella-zoster virus, Epstein-Barr virus and others are also significant pathogens. Fungal infections, caused by both yeasts and mycelial fungi, are associated with the highest mortality rates. Mycobacterial, pneumocystis, and parasitic diseases may also occur.
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Affiliation(s)
- R Patel
- Division of Infectious Diseases and Internal Medicine, Mayo Clinic, Rochester, Minnesota 55905, USA
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Robinson R, Murray PI, Willshaw HE, Raafat F, Kelly D. Primary ocular posttransplant lymphoproliferative disease. J Pediatr Ophthalmol Strabismus 1995; 32:393-4. [PMID: 8587027 DOI: 10.3928/0191-3913-19951101-16] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- R Robinson
- Department of Ophthalmology, Birmingham and Midland Eye Hospital, United Kingdom
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Kheterpal S, Kirkby GR, Neuberger JM, Rosenthal AR, Murray PI. Intraocular lymphoma after liver transplantation. Am J Ophthalmol 1993; 116:507-8. [PMID: 8213987 DOI: 10.1016/s0002-9394(14)71416-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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