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

PURPOSE: To determine the cross-sectional imaging findings of posttransplan tation 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 pr oved PTLD of the Waldeyer (lymphoid) ring or cervical lymph nodes were retr ospectively reviewed tor abnormalities. RESULTS: The interval between transplantation and PTLD onset was 3.5-108 mo nths (mean, 30 months). All patients had imaging abnormalities involving th e 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 ips ilateral nasopharynx in one). In three patients, the mass was centrally low attenuating at CT or isointense to fluid at MR imaging, with enhancing sol id 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 numer ous bilateral lymph nodes (mostly normal sized) in the anterior and posteri or cervical lymph chains. One patient also had a small mass in the upper me diastinum. 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.