孤立到 gastroesophageal 连接的 transplant 以后 lymphoproliferative 混乱的稀罕表示

• 作者: Brad M Haverkos Veeral M Oza Andrea Johnson Jon Walker Arwa Shana’ah
• 来源期刊: 世界胃肠肿瘤学杂志：英文版（电子版）
• 学科: 医学
• 关键词: B-CELL lymphoma Esophageal Lymphopro-liferative POST-TRANSPLANT Epstein BARR virus
• 年，卷（期）: 2013,（12）
• 页码范围: 230-234
• 页数: 5页
• 分类号: R735

摘要

Post transplant lymphoproliferative disorder (PTLD) represents a life threatening disorder occurring after transplantation, ranging from a polyclonal mononucleo- sis like illness to a monomorphic high grade neoplasm with cytologic and histopathologic evidence indica- tive of transformation to lymphoma. PTLD of diffuse large B-cell lymphoma (DLBCL) subtype, isolated to the esophagus is a rare diagnosis. We describe the first case of an immunocompromised adult patient diagnosed with DLBCL-PTLD limited to his esophagus without an associated mass or locoregional lymphade-nopathy on imaging since the institution of the revised Cheson criteria, which includes positron emission tomography-computed tomography as the standard staging modality. Even more unique to our case was the suggestion of underlying cytomegalovirus (CMV) gastritis leading to a hypothesis about a less well understood relationship between CMV and Epstein Barr virus (EBV). In the post transplant setting, im- munocompromised state, or EBV positive state, upper gastrointestinal symptoms should prompt investigation with an upper endoscopy (EGD). Additionally, specific to our case, the fact that the patients’ presentation was suspicious for CMV gastritis raises the possibility that the CMV infection predated his PTLD increasing his risk of acquiring PTLD. This reemphasizes the im- portance and diagnostic utility of early screening with EGD in patients after transplantation.