This Article  • Full text  • PDF  • Reply to article  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citing articles on HighWire  • Citing articles on Web of Science (11)  • Contact me when this article is cited  Related Content  • Similar articles in this journal  Topic Collections  • Viral Infections  • Pediatric Otolaryngology  • Liver Transplantation  • Diagnosis  • Liver/ Biliary Tract/ Pancreatic Diseases  • Immunology  • Infectious Diseases  • Alert me on articles by topic  Social Bookmarking   What's this?

Shelley Broughton, MD; John E. McClay, MD; Alan Murray, MD; Charles Timmons, MD; John Sommerauer, MD; Walter Andrews, MD; Paul Harkins, PhD

Arch Otolaryngol Head Neck Surg. 2000;126:1444-1447.

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.

From the Departments of Otolaryngology–Head and Neck Surgery (Drs Broughton, McClay, and Murray) and Pathology (Dr Timmons), University of Texas at Southwestern, Dallas; and the Departments of Critical Care Medicine (Dr Sommerauer) and Surgery (Dr Andrews), Childrens Mercy Hospital, Kansas City, Mo. Dr Harkins is at the University of Utah Medical School, Salt Lake City.

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Immunohistochemical Analysis and Epstein-Barr Virus in the Tonsils of Transplant Recipients and Healthy Controls
Mowry et al.
Arch Otolaryngol Head Neck Surg 2008;134:936-939.
ABSTRACT | FULL TEXT