Posttransplantation lymphoproliferative disorder of the head and neck: Imaging features in seven adults

PURPOSE: To determine the cross-sectional imaging findings of posttransplantation lymphoproliferative disorder (PTLD) of the head and neck. MATERIALS AND METHODS: Computed tomographic (CT) scans (n = 6) and magnetic resonance (MR) images (n = 2) in seven patients with histopathologically proved PTLD of the Waldeyer (lymphoid) ring or cervical lymph nodes were retrospectively reviewed for abnormalities. RESULTS: The interval between transplantation and PTLD onset was 3.5-108 months (mean, 30 months). All patients had imaging abnormalities involving the Waldeyer ring, and focal 2.0-4.5-cm masses were present in six patients (unilateral oropharyngeal tonsil in two, bilateral oropharyngeal tonsils in one, nasopharyngeal adenoids in three, unilateral pharyngeal tonsil and ipsilateral nasopharynx in one). In three patients, the mass was centrally low attenuating at CT or isointense to fluid at MR imaging, with enhancing solid peripheral lymphoid tissue. Three patients also had nodal findings: one with a 7-cm low- attenuating nodal mass in the right neck and two with numerous bilateral lymph nodes (mostly normal sized) in the anterior and posterior cervical lymph chains. One patient also had a small mass in the upper mediastinum. CONCLUSION: In the setting of organ transplantation, findings of masses in the Waldeyer ring or an excessive number of cervical nodes should increase the index of suspicion of PTLD.