Medical College of Wisconsin, USA
Gabriela Gheorghe is board certifi ed in hematopathology in addition to pediatric pathology and anatomic and clinical pathology. For the last 4 years, Gheorghe has provided hematopathology expertise to the Children Hospital of Wisconsin. A graduate of Institutul de Medicina Timisoara, Romania, Gheorghe is a Director of Hematology at the CHW, has published several papers in reputed Journals and is an active member of the Society for Pediatric Pathology and Children Oncology Group.
The presence of post-transplant lymphoproliferative disorders (PTLD) involving the central nervous system (CNS) is uncommon and can prove diagnostically challenging for the clinician and pathologist alike. Th e clinical and imaging characteristics of CNS PTLD can overlap those of infection, hemorrhage and primary CNS tumors making distinction from these entities difficult. When present, PTLD tends to occur in isolation, sparing other organ systems. It is therefore important to maintain a high index of suspicion for the disorder.Partly due to their rarity, CNS PTLD has not been fully characterized. While the understanding of the disease is increasing, the diagnosis and sometimes accurate classification of the brain PTLD lesions remains challenging. We recently published a series of pediatric autopsies with CNS PTLD, few of which exhibiting seconary meningeal involvement. In our series, PTLD was found outside the CNS in more than half of cases. It is important to consider CNS PTLD in this immunosupressed population at the very high risk for opportunistic infections as well. In the presence of abnormal brain imaging, the diagnosis could be made by CSF examination. Th e importance of CNS imaging with subsequent brain biopsy whenever clinically appropriate cannot be underestimated in this setting.