59 years old male, known case of post renal transplant was brought to the hospital with complaints of abdominal mass and discomfort.
Tru cut biopsy from omental deposit- IHC results confirm Non Hodgkin Lymphoma – Diffuse large B cell Lymphoma- non GCB type.
He received RCHOP on 08-05-19. He developed grade 4 neutropenia, NADR Total count was 100cells/ mm3.
Patient managed conservatively with Broad spectrum Antibiotics & GCSF.
Posttransplant lymphoproliferative disorders (PTLDs) are a group of diseases that range from benign polyclonal to malignant monoclonal lymphoid proliferations. They arise secondary to treatment with immunosuppressive drugs given to prevent transplant rejection. Three main pathologic subsets/stages of evolution are recognised: early, polymorphic, and monomorphic lesions. The pathogenesis of PTLDs seems to be multifactorial-EBV is main one .Antigenic stimulation Plasmacytoid dendritic cells (PDCs) , regulatory T cells are other factors .Whilst most are high-grade B-cell non-Hodgkin’s lymphoma (NHLs), a few are classical Hodgkin’s lymphomas. Rare cases have also been shown to be either of T-cell or NK-cell lineage
PTLD has a broad range of manifestations with extranodal involvement more common in the abdo- men than nodal involvement. In the abdomen, extranodal PTLD is seen as organ involvement, such as hepatic portal masses and bowel wall thickening.3 The anatomic distri- bution of PTLD is influenced by the allograft itself, pref- erentially in the anatomic region of the transplanted organ or within the allograft. The abdominal cavity is the body compartment most frequently involved by PTLD, and seen in 50–75% of patients with PTLD following renal, liver or heart transplantation.PET has emerged as an important diagnostic tool in the management of lymphoma with its superior sensitivity to anatomical imaging, particularly for extranodal disease