肾移植的诊断挑战:脾增生与移植后淋巴增生性疾病-一例报告

Jes M. Sanders, Daniel Galvez, Xiaoqi Lin, Joseph Leventhal
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引用次数: 0

摘要

脾萎缩是一种良性的、获得性的疾病,其特征是脾组织的局灶性沉积在整个腹膜腔内,最常见于脾损伤和/或脾切除术后。移植后淋巴细胞增生性疾病(PTLD)是实体器官移植的一种众所周知的并发症,它是由于慢性免疫抑制导致b细胞增殖不调节而引起的。鉴于其临床和放射学上的相似性,这两个实体可能在选择实体器官移植受者时造成诊断困境。我们提出的情况下,54岁肾移植受者提出腹痛,发现有腹膜后软组织肿块有关PTLD。他接受了ct引导下的肿块活检,组织病理学检查显示淋巴组织与脾组织一致,因此排除了PTLD。患者随后接受了症状治疗,最终症状得到缓解。PTLD的早期诊断是至关重要的,因为及时的干预对与此病相关的高发病率和死亡率有重大影响。此外,腹膜后肿物背景下脾萎缩的诊断是至关重要的,以避免可能导致严重并发症的侵入性诊断和治疗程序。详细的手术史,包括既往脾外伤和/或脾切除术,应提高临床对脾萎缩的怀疑,并指导进一步的诊断和治疗决策。
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Diagnostic Challenge in Renal Transplantation: Splenosis vs. Post-Transplant Lymphoproliferative Disorder—A Case Report
Splenosis is a benign, acquired condition characterized by the auto-implantation of focal deposits of splenic tissue throughout the peritoneal cavity, most commonly occurring after splenic injury and/or splenectomy. Post-Transplant Lymphoproliferative Disorder (PTLD) is a well-known complication of solid organ transplantation that results from unregulated B-cell proliferation due to chronic immunosuppression. Given their clinical and radiologic similarities, these two entities may pose a diagnostic dilemma in select solid-organ transplant recipients. We present the case of a 54-year-old kidney-transplant recipient presenting with abdominal pain and found to have a retroperitoneal soft-tissue mass concerning for PTLD. He underwent a CT-guided biopsy of the mass, and histopathological studies revealed lymphoid tissue consistent with splenic tissue, thus ruling out PTLD. The patient subsequently underwent symptomatic management, with the eventual resolution of his symptoms. The early diagnosis of PTLD is paramount, as prompt intervention has a substantial impact on the high rate of morbidity and mortality associated with this condition. Additionally, the diagnosis of splenosis in the setting of a retroperitoneal mass is critical in order to avoid invasive diagnostic and therapeutic procedures that may result in significant complications. A detailed surgical history, including prior splenic trauma and/or splenectomy, should raise clinical suspicion for splenosis and guide further diagnostic and therapeutic decision making.
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来源期刊
Cell and Organ Transplantology
Cell and Organ Transplantology Medicine-Transplantation
CiteScore
0.40
自引率
0.00%
发文量
8
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