Contrast-enhanced ultrasound findings of post-transplant lymphoproliferative disorder in a transplanted kidney: A case report and literature review - PubMed (original) (raw)

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Contrast-enhanced ultrasound findings of post-transplant lymphoproliferative disorder in a transplanted kidney: A case report and literature review

Alyssa Lampe et al. J Radiol Case Rep. 2015.

Abstract

Post-transplant lymphoproliferative disorder occurs in approximately one percent of kidney transplant recipients. We evaluated a seventy-seven year-old man with a solid mass in his transplant kidney. On contrast enhanced ultrasound, the mass enhanced but remained persistently hypovascular throughout exam. The enhancement pattern of the mass differed from that typical of clear cell renal cell carcinoma, the main differential diagnosis. Final pathology after partial nephrectomy confirmed post-transplant lymphoproliferative disorder. This is the first report of contrast enhanced ultrasound findings in a renal mass diagnosed as post-transplant lymphoproliferative disorder. Contrast enhanced ultrasound has a promising role in imaging of renal masses, particularly relevant in transplant patients due to the lack of nephrotoxicity.

Keywords: Contrast enhanced ultrasound; lymphoma; post-transplant lymphoproliferative disorder; renal transplant.

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Figures

Figure 1

Figure 1

Seventy-seven year-old man with post-transplant lymphoproliferative disorder. Findings: Axial (A), coronal (B), and sagittal (C) images show a round, centrally hypodense, 3 cm mass at the lower pole of the transplant kidney (arrow). Technique: Noncontrast CT of the abdomen and pelvis (Scanner: Multidetector CT Siemens Sensation 16-slice®. Protocol: 212mAs, 120kV, 3mm slice thickness).

Figure 2

Figure 2

Seventy-seven year-old man with post-transplant lymphoproliferative disorder. Findings: Longitudinal gray scale (A) and color Doppler (B) images demonstrate a solid, hypoechoic, hypovascular, cortically based mass (arrow) in the lower pole of the transplant kidney. Technique: Gray scale and color Doppler images of the right lower quadrant transplant kidney (Scanner: Phillips Epiq7®, curved probe, 1–5 MHz).

Figure 3

Figure 3

Seventy-seven year-old man with post-transplant lymphoproliferative disorder. Findings: Normal renal cortex (arrowhead), mass (arrow), and medullary pyramid (asterisk, *) are denoted on all images. Gray scale US (A) shows mass (arrow) in the lower pole transplant renal cortex. (B) Initial image from start of CEUS (0 seconds after injection) shows bright background echoes in the perinephric (P) and renal sinus (S) fat. The image is optimized to null renal signal, so renal cortex and mass are very hypoechoic. (C) Corticomedullary phase CEUS image (20 seconds) demonstrates early peripheral enhancement in the mass. Medullary pyramids hypoenhance in corticomedullary phase. (D) Parenchymal phase (also known as nephrographic, 30 seconds) CEUS image demonstrates progressive increase in peripheral enhancement in the mass, which remained persistently hypovascular to normal renal cortex throughout the exam. Medullary pyramid and cortex enhance similarly in this phase. (E) Delayed image (90 seconds) shows relative de-enhancement of kidney. Mass has minimal residual peripheral enhancement. (F) End of CEUS exam image (120 seconds) shows further de-enhancement, with appearance similar to (B), reflecting the minimal residual contrast in the blood pool at this time point. Note that the mass showed central non-enhancement, consistent with necrosis, throughout the CEUS exam. Technique: Gray scale and contrast-enhanced ultrasound (CEUS) images of the right lower quadrant transplant kidney (Scanner: Phillips Epiq7®, curved probe, 1–5 MHz).

Figure 4

Figure 4

Seventy-seven year-old man with post-transplant lymphoproliferative disorder. Findings: Gray scale image shows core biopsy needle in hypoechoic mass in lower pole of transplant kidney. Technique: Ultrasound image of the right lower quadrant transplant kidney (Scanner: Phillips Epiq7®, curved probe, 1–5 MHz).

Figure 5

Figure 5

Seventy-seven year-old man with post-transplant lymphoproliferative disorder. Findings: Tumor cells showed clear cytoplasm, which along with the sinusoidal vascular spaces, suggested clear cell renal cell carcinoma. No immunohistochemical stains were performed. Technique: Hematoxylin and eosin (x200) stain of the core needle biopsy specimen.

Figure 6

Figure 6

Seventy-seven year-old man with post-transplant lymphoproliferative disorder. Findings: Tumor from the partial nephrectomy showing a diffuse growth pattern with a few cells showing cytoplasmic clearing. Technique: Hematoxylin and eosin (x400) stain of the surgical partial nephrectomy specimen.

Figure 7

Figure 7

Seventy-seven year-old man with post-transplant lymphoproliferative disorder. Findings: Tumor from partial nephrectomy showing diffuse positivity for CD 20. Technique: High-power (x400) CD 20 immunohistochemical stain of the surgical partial nephrectomy specimen.

Figure 8

Figure 8

Seventy-seven year-old man with post-transplant lymphoproliferative disorder. Findings: Tumor cells show diffuse positivity for EBER by in situ hybridization. Technique: High-power (x400) EBV-encoded RNA (EBER) stain of the surgical partial nephrectomy specimen.

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