Case report: Bronchial carcinoma

Status: 
Ready to upload
Record number: 
1899
MPHO Type: 
Estimated frequency: 
Most recent risk assessment for Lung Cancer (Council of Europe, 2022): Any histotype of newly-diagnosed lung cancer is an unacceptable risk for organ donation. Lung cancer in the donor history: Treated lung cancer is considered to be associated with a high transmission risk. Risk may decrease after curative therapy, with recurrence-free time and with increasing probability of cure.
Time to detection: 
In the donor, the tumor was detected at necropsy after donation (no time span reported in the paper). The finding was communicated to the procurement surgeons but regrettably not to the transplant/recipient unit. In both kidney recipients, tumor metastases were detected at 13 and 18 months after transplant.
Alerting signals, symptoms, evidence of occurrence: 
In the donor (moderately heavy cigarette smoker for many years), the tumor was clinically silent. Necropsy revealed an 1.5cm nodule in the periphery of the upper right lung lobe which first was considered to be a healed tuberculous focus. Histology showed an anaplastic bronchial carcinoma of mixed fusiform and pleomorphic cell type, bizarre giant nuclei and considerable mitotic activity. Kidney recipient 1 showed deteriorating renal function due to extensive obstruction of the donor ureter at 13 months after transplant. Biopsy showed abnormal pleomorphic cells suggestive of neoplasia. 2 months later, she passed away and necropsy showed 2 tumors in the graft as well as adrenal glands with anaplastic tumor of fusiform and pleomorphic cells, nuclear atypism and mitotic activity. Kidney recipient 2 was diagnosed with chronic graft rejection. The kidney was removed 18 months after transplant and showed numerous tumor masses composed of undifferentiated pleomorphic cells and also fusiform polygonal cells with bizarre nuclei. He had additional rib and lung metastases. After cessation of immunosuppression, the lung lesion regressed but his health deteriorated and he died 20 months after transplant. Necropsy showed a large tumor mass at the site of the removed graft as well as liver, peritoneal and rib metastases. No evidence of the previous lung lesion
Demonstration of imputability or root cause: 
Histology showed the same tumor cell morphology in the donor and both kidney recipients.
Imputability grade: 
3 Definite/Certain/Proven
Groups audience: 
Suggest new keywords: 
malignancy
case report
kidney transplant
histologic analysis
lung and lower respiratory system
lung cancer, other
deceased donor
Suggest references: 
Forbes GB, Goggin MJ, Dische FE, Saeed IT, Parsons V, Harding MJ, et al. Accidental transplantation of bronchial carcinoma from a cadaver donor to two recipients of renal allografts. Journal of clinical pathology. 1981;34(2):109-15.
Note: 
First review done on September 27, 2018 (Kerstin) @Evi and Mike: should we think about adding a keyword "Lung cancer, anaplastic"? Or will "other" do? Maybe we should not become too detailed? I don´t know....thanks! I think this is just old terminology. It is either a poorly differentiated squamous carcinoma or adenocarcinoma. But we don't know which, not that it really matters in this circumstance. Mike
Expert comments for publication: 
Case from about 40 years ago but still very timely. This case shows the urgent need for reporting relevant necropsy findings to the recipient centers.