LYMPHOPROLIFERATIVE DISORDER: ENDOSCOPIC FINDINGS

Abstract

119 We describe a characteristic endoscopic finding noted in patients undergoing evaluation of lymphoproliferative disorder (LPD) for various indications. LPD is generally grouped into three types: infectious mononucleosis-type, localized, and disseminated disease. LPD may present with a variety of nonspecific symptoms and must be suspected in any transplant patient, particularly those with high risk factors. Common sites of presentation include the GI tract, the CNS and lymphoid tissue of the tonsils, mediastinum and mesentery. Despite the large incidence of GI involvement, we have found a paucity of information on the endoscopic findings in this disorder. During a two year period, 27 pediatric solid organ transplants were performed in 24 patients at Wilford Hall Medical Center. All received an initial immunosuppression with prednisone, 6-MP and oral FK506. The patients were maintained on oral FK506 with mean levels of 10-14. Episodes of acute rejection were managed with methylprednisolone bursts, and one patient received OKT3. Seven patients (6 hepatic and 1 renal transplant) were evaluated for suspected LPD. The presenting complaints included infectious mononucleosis-like illness (2,) diarrhea (3,) vomiting (1,) irritability and growth failure (1.) Two asymptomatic patients underwent evaluation based on serologic evidence (anti-IgM) of EBV reactivation. Six of seven patients underwent upper endoscopy and retrograde ileoscopy and one underwent upper endoscopy alone. All patients were found to have a characteristic raised erythematous lesion with a central umbilication, distinct from nodular lymphoid hyperplasia. The lesions were not ulcerated and ranged from 5-15mm in diameter. Lesions were predominantly found in the stomach and colon. Superficial ulceration, erythema, friability and loss of mucosal vascularity were also noted throughout the small and large bowel. Biopsies were all consistent with polyclonal LPD. Stains for CMV were negative. Specimens evaluated for EBV in situ hybridization were positive. Impression: Early diagnosis of LPD is essential for successful therapy. Although fulminant at times, LPD is often subtle and diagnosis can prove elusive. We support the routine use of panendoscopy for tissue diagnosis in the early detection of disseminated LPD.