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

Jin Hyuk Paek; Yae Rim Kim; Mi Hyun Jang; Eun Ah Hwang; Seung Yeup Han; Sung Bae Park

doi:10.4285/jkstn.2013.27.2.67

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Paek, Kim, Jang, Hwang, Han, and Park: A Brain Tumor from a Posttransplant Lymphoproliferative Disorder in a Kidney Transplant Recipient

Case Report

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

Published online: 11 June 2013

DOI: https://doi.org/10.4285/jkstn.2013.27.2.67

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

Jin Hyuk Paek, M.D.¹, Yae Rim Kim, M.D.¹, Mi Hyun Jang, M.D.^1,², Eun Ah Hwang, M.D., Ph.D.^1,², Seung Yeup Han, M.D., Ph.D.^1,², Sung Bae Park, M.D., Ph.D.^1,²

¹Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea

²Keimyung University Kidney Institute, Daegu, Korea

Correspondence：Seung Yeup Han, Department of Internal Medicine, Keimyung University School of Medicine, 56 Dalseong-ro, Jung-gu, Daegu 700-712, Korea Tel: +82-53-250-7913, Fax: +82-53-253-7976 E-mail: hansy@dsmc.co.kr

Received 21 April 201310 May 2013 Accepted 26 May 2013

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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.

Keywords: Posttransplant lymphoproliferative disorder, Kidney transplantation, Brain neoplasms

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Fig. 1.

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

Fig. 2.

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

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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