Post-Transplantation Lymphoproliferative disorders localizing in the adenotonsillar region: Report from the PTLD.Int survey
Hossein Khedmat, Saeed Taheri
Ann Transplant 2011; 16(1): 109-116
Background: The adenotonsillar region is an important localization for post-transplantation lymphoproliferative disorders (PTLD) due to its anatomical relevance. In this study, we sought to aggregate data of PTLD series reported by different international authors on tonsillar and adenoidal localization of PTLD and to compare their data with other PTLD patients.
Material/Methods: We conducted a comprehensive search for the available data by Pubmed and Google Scholar search engines for reports of lymphoproliferative disorders occurring within tonsils and adenoids among organ transplant patients. Data from 22 previously published studies from various countries were included into analysis.
Results: Overall, 352 patients with lymphoproliferative disorders after organ transplantation were entered into analysis. Patients with adenotonsillar PTLD were significantly younger (13±15 vs. 26±23 yr/o; p<0.0001), more frequently females (56% vs. 35%; p=0.013), less likely to develop metastasis (4.5% vs. 12.5%; p=0.07), and were more frequently from polyclonal (80% vs. 53%; p=0.002) and polymorphic (68% vs. 27%; p=0.001) histopathologic features. Adenotonsillar PTLD also had a significantly superior survival than other PTLD localizations during the first 4 year after diagnosis (p=0.031). Five-year survival rates for adenotonsillar PTLD and other PTLD localizations were 54% and 39%, respectively.
Conclusions: We found that adenotonsillar localization by PTLD is a relatively benign disease with respect to its histological features and survival compared to other sites of PTLD involvement. Adenotonsillar PTLD is more prevalent in younger patients, females and liver transplant recipients. Therefore, to enhance early detection and treatment, we seek to alert doctors about any adenotonsillar symptoms in pediatric transplant recipients.
Keywords: post transplant lymphoproliferative disorders, PTLD, adenotonsillar hypertrophy, localization of neoplasm