Malignant Post-Transplant Lymphoproliferative Disorder of Nasopharynx in Myelodysplastic Disorder

Chih-Wei Luan,Geng-He Chang,Cheng-Ming Hsu,Chih-Cheng Chen,Yao-Te Tsai,Kam-Fai Lee,Ming-Shao Tsai

doi:10.3390/healthcare9020217

Abstract

(1) Background: Post-transplant lymphoproliferative disorder (PTLD) is a hematological disease and occurs because of immunosuppression after organ transplantation. Only a few studies have reported PTLD in the nasopharynx. In most cases, PTLD developed after solid organ transplantation, and cases of PTLD after bone marrow transplantation, are uncommon. (2) Case presentation: We report the case of a 40-year-old woman with myelodysplastic disorder who underwent hematopoietic stem cell transplantation (HSCT). After 3 months, she developed low-grade fever, progressive nasal obstruction, and bloody rhinorrhea. Endoscopy revealed a mass completely occupying the nasopharynx. A polymorphic PTLD was diagnosed on the basis of histopathological examination results. Reduction in immunosuppression and low-dose radiotherapy were prescribed for treatment. After a 3-year follow-up, no recurrence of PTLD or myelodysplastic disorder was detected. (3) Conclusions: While nasopharyngeal PTLD is rare, a routine examination of the nasopharynx should be considered in the post-transplant follow-up of patients for early detection and treatment of PTLD.

Highlights

Immunosuppressive agents used to reduce post-transplantation rejection reactions might cause serious complications, such as post-transplant lymphoproliferative disorder (PTLD), a hematological disorder strongly associated with Epstein–Barr virus (EBV) infection [1]
According to the fourth edition of the World Health Organization lymphoma classification, Post-transplant lymphoproliferative disorder (PTLD) comprises four subgroups based on histopathological features, including early lesions, polymorphic PTLD, monomorphic PTLD (B cell lymphomas and T/NK lymphomas), and classic Hodgkin lymphoma PTLD [2]
We report a rare case of polymorphic PTLD with nasopharyngeal manifestation after hematopoietic stem cell transplantation (HSCT) and present the clinical images and histopathological features

Summary

Conclusions

Development of a nasopharyngeal PTLD following HSCT is a rare but a potentially fatal condition. Clinicians should pay attention to potential complications in patients undergoing organ transplantation, and a routine pharyngeal examination for those patients should be considered to facilitate immediate diagnosis and early treatment. Conflicts of Interest: The authors declare no conflict of interest. Ethics approval and consent to participate: The publication of this case report was approved by the Institutional Review Board of Chang Gung Memorial Hospital (No.: 202001753B0). Consent for publication: The data used in the article was permitted by the patient with consent for publication. Availability of data and materials: All data generated or analyzed during this study are included in this published article

Introduction

Case Presentation

Findings

Discussion