Khedmat Hossein, Taheri Saeed
The Internist Center; Baqiyatallah University of Medical Sciences, Tehran, Iran.
Ann Transplant. 2011 Jan-Mar;16(1):109-16.
The adenotonsillar region is an important localization for post-transplantation lymphoproliferative disorders (PTLD) due to its anatomical relevance. In this study, we sought to aggregate data of PTLD series reported by different international authors on tonsillar and adenoidal localization of PTLD and to compare their data with other PTLD patients.
MATERIAL/METHODS: We conducted a comprehensive search for the available data by Pubmed and Google Scholar search engines for reports of lymphoproliferative disorders occurring within tonsils and adenoids among organ transplant patients. Data from 22 previously published studies from various countries were included into analysis.
Overall, 352 patients with lymphoproliferative disorders after organ transplantation were entered into analysis. Patients with adenotonsillar PTLD were significantly younger (13 ± 15 vs. 26 ± 23 yr/o; p < 0.0001), more frequently females (56% vs. 35%; p = 0.013), less likely to develop metastasis (4.5% vs. 12.5%; p = 0.07), and were more frequently from polyclonal (80% vs. 53%; p = 0.002) and polymorphic (68% vs. 27%; p=0.001) histopathologic features. Adenotonsillar PTLD also had a significantly superior survival than other PTLD localizations during the first 4 year after diagnosis (p = 0.031). Five-year survival rates for adenotonsillar PTLD and other PTLD localizations were 54% and 39%, respectively.
We found that adenotonsillar localization by PTLD is a relatively benign disease with respect to its histological features and survival compared to other sites of PTLD involvement. Adenotonsillar PTLD is more prevalent in younger patients, females and liver transplant recipients. Therefore, to enhance early detection and treatment, we seek to alert doctors about any adenotonsillar symptoms in pediatric transplant recipients.
由于其解剖学相关性，腺样体扁桃体区域是移植后淋巴增生性疾病（PTLD）的一个重要发病部位。在本研究中，我们试图汇总不同国际作者报道的PTLD系列中关于PTLD扁桃体和腺样体发病部位的数据，并将他们的数据与其他PTLD患者的数据进行比较。
材料/方法：我们通过PubMed和谷歌学术搜索引擎对可用数据进行了全面检索，以查找器官移植患者扁桃体和腺样体中发生的淋巴增生性疾病的报告。来自不同国家的22项先前发表的研究数据被纳入分析。
总体而言，352例器官移植后淋巴增生性疾病患者被纳入分析。腺样体扁桃体PTLD患者明显更年轻（13±15岁 vs. 26±23岁；p<0.0001），女性更常见（56% vs. 35%；p=0.013），发生转移的可能性更小（4.5% vs. 12.5%；p=0.07），并且更常具有多克隆（80% vs. 53%；p=0.002）和多形性（68% vs. 27%；p=0.001）组织病理学特征。在诊断后的前4年，腺样体扁桃体PTLD的生存率也显著高于其他PTLD发病部位（p=0.031）。腺样体扁桃体PTLD和其他PTLD发病部位的5年生存率分别为54%和39%。
我们发现，与PTLD累及的其他部位相比，PTLD的腺样体扁桃体发病部位在组织学特征和生存率方面是一种相对良性的疾病。腺样体扁桃体PTLD在年轻患者、女性和肝移植受者中更为普遍。因此，为了加强早期检测和治疗，我们试图提醒医生注意小儿移植受者中的任何腺样体扁桃体症状。
