Wewel Joshua T, Harbhajanka Aparna, Kasliwal Manish K, Ahuja Sumeet K, Loew Jerome M, Fontes Ricardo B
Department of Neurosurgery, Rush University Medical Center, 1725 W. Harrison Street, Suite 855, Chicago, IL 60612, USA.
Department of Pathology, Rush University Medical Center, Chicago, IL, USA.
J Clin Neurosci. 2016 Jul;29:175-8. doi: 10.1016/j.jocn.2016.01.015. Epub 2016 Feb 23.
Post-transplant lymphoproliferative disease (PTLD) is a recognized complication following solid organ and stem cell transplants with subsequent immunosuppression and is the most common malignancy complicating solid organ transplantation. Improved survival and use of aggressive immunosuppression following solid organ transplants have led to increased diagnosis of PTLD. Nevertheless, spinal involvement in PTLD is extremely rare. To our knowledge, this is the first report of PTLD causing epidural spinal cord compression of the cervical spine, mimicking the imaging and pathology of an epidural abscess. The patient underwent posterior and subsequent anterior decompression and stabilization. Rarity of occurrence of PTLD in the spine with absence of diagnostic imaging features may preclude differentiating it from the more commonly occurring lesions such as epidural abscess which occurs in a similar clinical setting. As the management strategy and overall prognosis are dramatically different, the importance of considering PTLD in the differential diagnosis for epidural spinal cord compression in a transplant recipient patient cannot be overemphasized.
移植后淋巴细胞增生性疾病（PTLD）是实体器官和干细胞移植后，因后续免疫抑制而出现的一种公认并发症，是实体器官移植中最常见的恶性肿瘤并发症。实体器官移植后生存率提高以及强效免疫抑制的使用导致PTLD诊断增加。然而，PTLD累及脊柱极为罕见。据我们所知，这是首例PTLD导致颈椎硬膜外脊髓压迫的报告，其影像学和病理学表现类似硬膜外脓肿。患者接受了后路及随后的前路减压和固定手术。PTLD在脊柱发生率低且缺乏诊断性影像学特征，这可能使其难以与在类似临床环境中更常见的病变（如硬膜外脓肿）相鉴别。由于管理策略和总体预后差异巨大，对于移植受者患者硬膜外脊髓压迫的鉴别诊断中考虑PTLD的重要性再怎么强调也不为过。
