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POST-TRANSPLANT MALIGNANCY IN THE COLON: PTLD OR NOT-PTLD
KI Kroeker, S Girgis, D Kao
University of Alberta, Edmonton, AB
BACKGROUND: Post-transplant lymphoproliferative disorder (PTLD) is an important diagnostic consideration in post-transplant patients presenting with symptoms suggestive of malignancy. Yet the endoscopic appearance of gastrointestinal PTLD has not been well described. Two cases of post-transplant colonic malignancy with abdominal lymphadenopathy and a review of literature on PTLD are presented.
CASE REPORTS: Case #1: A 61-year old man, 14 years post cardiac transplant, presented with new-onset ascites and non-bloody diarrhea. A CT scan showed segmental thickening of transverse colon and two large soft tissue densities suggestive of lymphadenopathy. A 10 cm ulcerated mass was found at colonoscopy. Biopsies confirmed monomorphic B-cell PTLD (diffuse large B-cell lymphoma).
Case #2: A 66-year old man, 21 months post liver transplantation, presented with abdominal pain and distension. A CT scan found a thickened cecum, innumerable intra-abdominal lymph nodes, and moderate ascites. On colonoscopy, a nodular mass was identified in the cecum. Biopsies were consistent with metastatic adenocarcinoma. One week later, the patient underwent a right hemicolectomy which demonstrated a moderately differentiated metastatic adenocarcioma. Extensive immunohistochemical staining was suggestive of a gastric primary. The patient died before a gastroscopy was performed. Autopsy was declined.
CONCLUSION: We report 2 cases of post transplant patients with colonic masses and intra-abdominal lymphadenopathy, one with PTLD and one with secondary colon cancer with a possible gastric primary. PTLD can affect the gastrointestinal tract in approximately 10-15% of post transplant patients with PTLD. Secondary colon cancer is uncommon, with possible primary originating from kidney, lung, melanoma, or stomach. The colonic lesions in this patient population may provide clues but not enough distinctive features to allow an endoscopist to make a diagnosis based on endoscopic appearance alone.