Rawashdeh Badi, Papageorge Christina, Al-Adwan Yazan
Division of Transplant Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA.
Division of Transplant Surgery, Department of Surgery, University of Virginia School of Medicine, UVA Health, Charlottesville, VA, USA.
Am J Case Rep. 2025 Jan 23;26:e945837. doi: 10.12659/AJCR.945837.
BACKGROUND Post-transplant lymphoproliferative disorder (PTLD) encompasses a group of disorders ranging from hyperplastic to malignant lymphoid proliferations in the post-transplant period owing to immunosuppression, often in the setting of EBV transformation. PTLD is a rare complication of immunosuppression that, like lymphomas, can have a variable presentation based on disease localization. We report a case of PTLD mass effect at the porta hepatis for the first time in the literature, resulting in hepatic artery stenosis (HAS) and common hepatic duct obstruction. CASE REPORT A 54-year-old woman presented with cholestasis 4 months after receiving a deceased donor liver transplant. MRCP revealed a mass at the porta hepatis causing biliary compression, which resolved with subsequent biliary stenting. The woman presented again 3 weeks later with a similar presentation. CT revealed that the mass had enlarged, causing HAS, which resolved with subsequent hepatic artery stenting. The biopsy revealed PTLD, and the patient was successfully managed with rituximab and a reduction of her immunosuppressive regimen. CONCLUSIONS This case report describes a rare occurrence of PTLD, which particularly impacting the porta hepatis, resulting in HAS and compression of the bile duct. PTLD should be considered in the differential diagnosis for obstructive jaundice and hepatic artery compression, even in the early post-transplant months, when these symptoms are often attributed to surgical factors.
背景 移植后淋巴组织增生性疾病（PTLD）包括一组在移植后由于免疫抑制（通常在EBV转化的情况下）而发生的从增生性到恶性淋巴样增生的疾病。PTLD是免疫抑制的一种罕见并发症，与淋巴瘤一样，其临床表现会因疾病定位的不同而有所变化。我们首次在文献中报道了一例发生于肝门部的PTLD肿块效应，导致肝动脉狭窄（HAS）和肝总管梗阻。病例报告 一名54岁女性在接受已故供体肝脏移植4个月后出现胆汁淤积。磁共振胰胆管造影（MRCP）显示肝门部有一肿块导致胆管受压，随后通过胆管支架置入，症状缓解。3周后该女性再次出现类似症状。CT显示肿块增大，导致肝动脉狭窄，随后通过肝动脉支架置入，症状缓解。活检显示为PTLD，患者通过利妥昔单抗治疗及减少免疫抑制方案而成功治愈。结论 本病例报告描述了一种罕见的PTLD病例，其特别影响肝门部，导致肝动脉狭窄和胆管受压。即使在移植后的早期数月，当这些症状常被归因于手术因素时，在梗阻性黄疸和肝动脉受压的鉴别诊断中也应考虑PTLD。
