Archives of otolaryngology--head & neck surgery · 2000
The effectiveness of tonsillectomy in diagnosing lymphoproliferative disease in pediatric patients after liver transplantation.
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Broughton S, McClay J E, Murray A, Timmons C, Sommerauer J, Andrews W, Harkins P
Аннотация
OBJECTIVE: To determine the effectiveness of diagnosing forms of lymphoproliferative disease by performing tonsillectomy in pediatric patients who develop symptomatic or asymptomatic tonsillar hypertrophy during immunosuppressive therapy after liver transplantation.
DESIGN: Retrospective chart and pathological review.
SETTING: Urban tertiary referral children's hospital.
MAIN OUTCOME MEASURES: The presence of a pathological stage of lymphoproliferative disease or Epstein-Barr virus (EBV) diagnosed using tonsillar specimens, resulting in a change in therapy.
RESULTS: Of 275 pediatric patients who underwent liver transplantation, 13 had tonsillectomy performed with histopathological review of the tonsillar specimens. The specimens from 5 patients (39%) demonstrated pathological changes thought to be consistent with EBV-related changes or a form of lymphoproliferative disease. Histological changes ranged from tonsillar hyperplasia associated with EBV infection to large cell lymphoma. Immunosuppressive therapy was reduced or discontinued, and antiviral therapy was initiated.
CONCLUSION: Children who have undergone liver transplantation and develop tonsillar hypertrophy should undergo a diagnostic tonsillectomy, regardless of the clinical presentation, to rule out a form of posttransplant lymphoproliferative disease. Arch Otolaryngol Head Neck Surg. 2000;126:1444-1447
DESIGN: Retrospective chart and pathological review.
SETTING: Urban tertiary referral children's hospital.
MAIN OUTCOME MEASURES: The presence of a pathological stage of lymphoproliferative disease or Epstein-Barr virus (EBV) diagnosed using tonsillar specimens, resulting in a change in therapy.
RESULTS: Of 275 pediatric patients who underwent liver transplantation, 13 had tonsillectomy performed with histopathological review of the tonsillar specimens. The specimens from 5 patients (39%) demonstrated pathological changes thought to be consistent with EBV-related changes or a form of lymphoproliferative disease. Histological changes ranged from tonsillar hyperplasia associated with EBV infection to large cell lymphoma. Immunosuppressive therapy was reduced or discontinued, and antiviral therapy was initiated.
CONCLUSION: Children who have undergone liver transplantation and develop tonsillar hypertrophy should undergo a diagnostic tonsillectomy, regardless of the clinical presentation, to rule out a form of posttransplant lymphoproliferative disease. Arch Otolaryngol Head Neck Surg. 2000;126:1444-1447
Предметные рубрики MeSH
Antiviral AgentsChildEpstein-Barr Virus InfectionsFollow-Up StudiesHerpesvirus 4, HumanHumansHyperplasiaHypertrophyImmunosuppression TherapyIn Situ HybridizationJejunal NeoplasmsLiver TransplantationLymphoma, Large B-Cell, DiffuseLymphoproliferative DisordersPalatine TonsilPostoperative ComplicationsRNA, MessengerRNA, ViralRetrospective StudiesTime FactorsTonsillar NeoplasmsTonsillectomy