Adenotonsillar histopathology offer organ transplantation

OBJECTIVES: The increasing number of surviving pediatric organ transplant r ecipients has resulted in a new clinical controversy surrounding the signif icance of adenotonsillar hypertrophy. The objective of this study is to eva luate adenotonsillar specimens, understand characteristic histopathology, a nd to examine the frequency and significance of this finding in this popula tion. METHODS., Twenty-one cases of pediatric transplant recipients with adenoida l and/or tonsillar hypertrophy were reviewed retrospectively in a tertiary- care setting. Particular attention was given to the histopathology of their surgical specimens, including any evidence of posttransplantation lymphopr oliferative disorders (PTLD). RESULTS: Using morphologic, immunohistochemical, and molecular genetic anal yses, 15 (71%) of 21 patients were noted to have Epstein-Barr virus (EBV)-r elated lymphoid hyperplasia, including I case (4.7%) of PTLD. Six (29%) of 21 had evidence of reactive follicular hyperplasia not related to EBV. B-ce ll and T-cell markers were nearly uniformly positive when tested for, excep t in the single patient with PTLD, who exhibited polymorphic, polyclonal B- cell morphology. Kappa and lambda light-chain clonality markers were positi ve in 11 (92%) of 12 patients. CONCLUSIONS. EBV-related lymphoid hyperplasia is frequently associated with adenotonsillar hypertrophy in pediatric organ transplant patients (71% of our cases); 92% of those cases tested exhibit polyclonal B-cell populations . PTLD, an important cause of morbidity and mortality in this population, r epresented approximately 5% of our cases. The remainder of cases represent follicular hyperplasia unrelated to EBV or lymphoproliferative abnormalitie s. Characteristic histopathologic findings are presented.