Post-transplant lymphoproliferative disorder of the bladder in a lung transplant recipient

Abstract

Post-transplant lymphoproliferative disorder (PTLD) occurs in ~5% of solid organ and hematopoietic stem cell transplant recipients. We report a unique presentation of PTLD in the bladder of a lung transplant recipient. Our patient was a 62-year-old female who received a bilateral lung transplant for chronic obstructive pulmonary disease. She presented with fever, left-sided flank pain and foul-smelling urine consistent with urosepsis. An abdominal and pelvic computerized tomography revealed an irregular and nodular bladder wall thickening suspicious for urothelial neoplasm. Cystoscopy revealed multiple bladder masses and biopsy demonstrated non-Hodgkin lymphoma consistent with PTLD. She was treated with a reduction in immunosuppression followed by chemotherapy and achieved remission. PTLD in the lung transplant recipients has been described in the gut, respiratory tract, skin, liver and kidney but not in the bladder. This case highlights the need for maintaining a high clinical vigilance even when transplant recipients present with seemingly benign clinical complaints.

Figure 1:

This figure shows the pre-treatment imaging (A) CT scan of the abdomen and pelvis with bladder wall thickening (yellow arrows) and (B) PET scan with pre-vascular avid lymph node (SUV:14) for staging pre-treatment (yellow arrow).

Figure 2:

The H&E (A) section showed a diffuse sheet of monomorphic large B-cells expressing CD-20 (B) and CD-10 (C) with a high Ki-67 (D) proliferation fraction (>90%)

Figure 3:

CT scan of the abdomen and pelvis pre-treatment image with yellow arrows (A) and post-treatment image with blue arrows (B) showing the resolution of the bladder wall thickening.

Figure 4:

PET scan image of the anterior chest pre-vascular lymph node pre-treatment with yellow arrow (A) and post-treatment image with blue arrow (B) showing resolution of the PET avid lymph node.