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post - transplant lymphoproliferative disorder ( ptld ) is a rare , but life - threatening disorder , characterized by an uncontrolled proliferation of lymphocytes , caused by immunosuppressive drug - induced diminished immune surveillance . the majority of monomorphic ptld cases are non - hodgkin 's lymphoma of b - cell origin ; in contrast , t - cell lymphoma and hodgkin 's disease are rare .
we report imaging features of fluorodeoxyglucose - positron emission tomography / computed tomography ( fdg - pet / ct ) with monomorphic non - hodgkin lymphoma ptld in a post renal transplant .
this was a case report of a 32-year - old female patient who had immunoglobulin a nephropathy underwent renal transplant 6 years before and was on immunosuppressants .
she is postpartum 6 months and breast feeding , presented with swelling in the right inguinal region .
she underwent an excision biopsy of the right inguinal node , which showed diffuse large b cell lymphoma .
as a part of evaluation , she was subjected to whole body pet / ct , which showed increased uptake in multiple nodes in right external iliac and inguinal region [ figure 1a and b ] , also right breast parenchyma uptake [ figure 1c ] and transplant kidney noted in right iliac fossa [ figure 1d ] . as pet / ct scan confirmed involvement of multiple nodes , patient underwent chemotherapy and asked to stop breast feeding .
whole body fluorodeoxyglucose - positron emission tomography / computed tomography ( pet / ct ) maximum intensity projection image ( a ) , axial fused pet / ct showed an intense uptake in the right external iliac lymphnodes ( b ) , right breast parenchyma uptake due to lactation ( c ) and transplant kidney in right iliac fossa ( d ) noted
ptld are a heterogeneous group of abnormal lymphoid proliferations that occur after solid organ transplant or hematopoietic transplantation .
ptlds consist of a disease spectrum ranging from hyperplasia to aggressive lymphomas with 60 to 70% being epstein - barr virus ( ebv ) positive .
the majority of cases are b - cell , although 10 - 15% is of t - cell origin or rarely hodgkin lymphoma . in the initial stages of ptld
the incidence rate of monomorphic ptld was 0.24% and the median time between the transplant and diagnosis of ptld was 85.8 months .
the immunosuppression required to prevent graft rejection post transplantation impairs t - cell immunity , potentially allowing for uncontrolled proliferation of ebv - infected b - cells , which may result in a spectrum of b - cell proliferations that range from hyperplasia to true lymphoma .
it often presents with a later onset , monomorphic histology and a more aggressive course than ebv - positive ptld , suggesting that it may have a different pathophysiology .
experience with the use of pet in ptld has been limited to case reports and rather small single - center case series .
these reports reveal that pet scan may have a high sensitivity for the detection of ptld lesions .
fdg uptake pattern have been useful in predicting the benign or malignant nature of nodes . in our case ,
our case thus illustrates that fdg pet / ct is an important imaging modality for the detection and accurate staging and restaging of ptld and to decide upon appropriate treatment .
post - transplant lymphoproliferative disorder ( ptld ) is a heterogeneous group of lymphoid proliferations caused by immunosuppression after solid organ or bone marrow transplantation . 
 ptld is categorized by early lesion , polymorphic ptld and monomorphic ptld . 
 fluorine-18 fluorodeoxyglucose - positron emission tomography / computed tomography ( f-18 fdg - pet / ct ) scans have clinical significance in the evaluation of ptld following renal transplantation . 
 we report imaging findings of a monomorphic non - hodgkin lymphoma , post renal transplant seen on fdg pet / ct in a 32-year - old lactating woman . 
 whole body fdg- et / ct demonstrated uptake in right external iliac and inguinal lymph nodes .