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Malvi D, Vasuri F, Albertini E, Carbone M, Novelli L, Mescoli C, Cardillo M, Pagni F, D'Errico A, Eccher A. Donors risk assessment in transplantation: From the guidelines to their real-world application. Pathol Res Pract 2024; 255:155210. [PMID: 38422913 DOI: 10.1016/j.prp.2024.155210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 02/08/2024] [Accepted: 02/11/2024] [Indexed: 03/02/2024]
Abstract
Transplantation of an organ from a donor carries an unavoidable risk of tumor transmission. The need to extend the donor pool increases the use of organs from donors with malignancies and potential disease transmission is a constant tension influencing donor suitability decisions. Current classification systems for the assessment of donor malignancy transmission risk have evolved from reports of potential transmission events in recipients to national donation and transplant surveillance agencies. Although the risk of malignancy transmission is very low in the general transplant setting it must constantly be balanced with the transplant benefits. Guidelines are mainly based on large registries and sparse case reports of transmission, so they cannot cover all the possible situations. For this reason, in 2004 in Italy, the National Transplant Center gave rise to the Second Opinion Service, charged by the Ministry of Health, by structuring expertise in diagnostic oncology and risk transmission and making it available to the Italian Transplant Centers. In this paper the registry of the Italian Oncological Second Opinion was reviewed, from 2016 to 2018, to detail the most frequent and problematic neoplastic topics addressed, those are separately reported and discussed. Furthermore, a review of the most recent strategies and risk stratification is provided, according to the most recent literature evidence and to the European Guidelines.
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Affiliation(s)
- Deborah Malvi
- Pathology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy
| | - Francesco Vasuri
- Pathology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy
| | - Elisa Albertini
- Pathology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy; School of Anatomic Pathology, Department of Biomedical and Neuromotor Sciences, University of Bologna, Italy
| | - Maurizio Carbone
- University Milan Bicocca, Department of Medicine and Surgery, Departmental Center of Digital Medicine, Milan, Italy
| | - Luca Novelli
- Institute of Histopathology and Molecular Diagnosis, Careggi University Hospital, Florence, Italy
| | - Claudia Mescoli
- Surgical Pathology and Cytopathology Unit, Department of Medicine, University and Hospital Trust of Padua, Italy
| | - Massimo Cardillo
- Italian National Transplantation Center, Italian National Institute of Health, Rome, Italy
| | - Fabio Pagni
- University Milan Bicocca, Department of Medicine and Surgery, Departmental Center of Digital Medicine, Milan, Italy
| | - Antonia D'Errico
- Pathology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy.
| | - Albino Eccher
- Section of Pathology, Department of Medical and Surgical Sciences for Children and Adults, University of Modena and Reggio Emilia, University Hospital of Modena, Modena, Italy
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2
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Lapointe M, Kerbaul F, Meckert F, Cognard N, Mathelin C, Lodi M. [Breast cancer and organ transplantation: Systematic review and meta-analysis]. GYNECOLOGIE, OBSTETRIQUE, FERTILITE & SENOLOGIE 2023; 51:60-72. [PMID: 36375787 DOI: 10.1016/j.gofs.2022.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 11/04/2022] [Accepted: 11/04/2022] [Indexed: 11/13/2022]
Abstract
OBJECTIVES Our main objective was to investigate donor-transmitted epithelial cancers of all origins in comparison with breast cancers, with analysis of the carcinological outcome of recipients. Our secondary objective was to define medical check-up to be performed before any organ procurement from a donor with a history of breast cancer. METHODOLOGY We performed a systematic review of the literature up to June 1st 2022 by including all original articles (including clinical cases) reporting cases of epithelial cancer transmitted from donor to recipient, followed by a meta-analysis of epidemiological and survival data. RESULTS In total, we included 52 articles (31 clinical cases and 21 cohort studies), representing 91,388 donors, 236,142 recipients, and 2591 cases of transmitted cancer. The risk of transmitted cancer was significantly higher with a history of breast cancer compared with a history of other cancer (RR=9.48 P=0.0025). In clinical cases, the pre-donation check-up was specified in only 33.3% of publications. The time between transplantation and cancer occurrence was longer in cases of breast cancer transmission compared to other epithelial cancers: 1435.8 days versus 297.6 (P<0.001). CONCLUSION Organ donation from a person previously treated for breast cancer or having a risk of occult breast cancer is possible in some situations but requires an adapted pre-donation assessment, the respect of good practice guidelines and an expert opinion in complex situations.
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Affiliation(s)
- M Lapointe
- CHRU, 1, avenue Molière, 67200 Strasbourg, France
| | - F Kerbaul
- Direction prélèvement et greffe organes et tissus, direction générale médicale et scientifique, agence de la biomédecine, 93212 La Plaine cedex, France
| | - F Meckert
- Direction prélèvement et greffe organes et tissus, direction générale médicale et scientifique, agence de la biomédecine, 93212 La Plaine cedex, France
| | - N Cognard
- CHRU, 1, avenue Molière, 67200 Strasbourg, France
| | - C Mathelin
- CHRU, 1, avenue Molière, 67200 Strasbourg, France; Institut de cancérologie Strasbourg Europe (ICANS), 17, avenue Albert-Calmette, 67200 Strasbourg cedex, France; Institut de génétique et de biologie moléculaire et cellulaire (IGBMC), CNRS, UMR7104 Inserm U964, université de Strasbourg, 1, rue Laurent-Fries, 67400 Illkirch-Graffenstaden, France.
| | - M Lodi
- CHRU, 1, avenue Molière, 67200 Strasbourg, France; Institut de cancérologie Strasbourg Europe (ICANS), 17, avenue Albert-Calmette, 67200 Strasbourg cedex, France; Institut de génétique et de biologie moléculaire et cellulaire (IGBMC), CNRS, UMR7104 Inserm U964, université de Strasbourg, 1, rue Laurent-Fries, 67400 Illkirch-Graffenstaden, France
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3
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Devaraj S, Panda SS, Sahu D, Mohapatra D, Agarwal BD, Biswas G, Moharana L, Kilaru S, Kolluri S. Gestational Choriocarcinoma Manifesting as Spontaneous Hemothorax in Third Trimester of Pregnancy: A Case Report. Indian J Med Paediatr Oncol 2022. [DOI: 10.1055/s-0042-1758525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
AbstractGestational trophoblastic neoplasia (GTN) is an aggressive malignancy arising from the trophoblastic tissue. It is rarely seen in association with advanced intrauterine pregnancy. Most common manifestations are due to bleeding caused by the rich vascularity of trophoblastic tissue. We describe here a case of a 28-year-old female patient who presented to us at 32 weeks of pregnancy with sudden onset dyspnea and hemodynamic instability. On evaluation, imaging techniques revealed a gross left hemothorax requiring intercostal tube insertion for stabilization. Emergency thoracotomy and hemothorax drainage were performed wherein a tumor mass in the lower lobe of left lung was identified and resected. Histopathological examination confirmed the diagnosis of choriocarcinoma. Beta HCG levels were found to be elevated. Final diagnosis of a FIGO stage IV high-risk gestational choriocarcinoma was made. Following this, six cycles of multi-agent EMA-CO chemotherapy was administered to the patient. Patient had an excellent response to treatment with documented serial fall in β HCG levels and she continues to be in remission after 6 months of follow-up. In conclusion, in the circumstance of any pregnant women presenting with abnormal bleeding symptoms such as hemothorax, choriocarcinoma as a cause should be considered for early diagnosis and effective management.
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Affiliation(s)
- Suma Devaraj
- Department of Medical Oncology, Institute of Medical Sciences & SUM Hospital, Bhubaneswar, Odisha, India
| | - Soumya Surath Panda
- Department of Medical Oncology, Institute of Medical Sciences & SUM Hospital, Bhubaneswar, Odisha, India
| | - Debasish Sahu
- Department of Cardiothoracic Vascular Surgery, Institute of Medical Sciences & SUM Hospital, Bhubaneswar, Odisha, India
| | - Debahuti Mohapatra
- Department of Pathology, Institute of Medical Sciences & SUM Hospital, Bhubaneswar, Odisha, India
| | - Beena Devi Agarwal
- Department of Radiodiagnosis, Institute of Medical Sciences & SUM Hospital, Bhubaneswar, Odisha, India
| | - Ghanashyam Biswas
- Department of Medical Oncology, Institute of Medical Sciences & SUM Hospital, Bhubaneswar, Odisha, India
| | - Lalatendu Moharana
- Department of Medical Oncology, Institute of Medical Sciences & SUM Hospital, Bhubaneswar, Odisha, India
| | - Sindhu Kilaru
- Department of Medical Oncology, Institute of Medical Sciences & SUM Hospital, Bhubaneswar, Odisha, India
| | - Spoorthy Kolluri
- Department of Medical Oncology, Institute of Medical Sciences & SUM Hospital, Bhubaneswar, Odisha, India
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Sakurai S, Asano R, Furugori M, Shigeta H. A rare case of gestational ovarian choriocarcinoma coexistent with intrauterine pregnancy. Taiwan J Obstet Gynecol 2022; 61:708-712. [PMID: 35779927 DOI: 10.1016/j.tjog.2021.09.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/24/2021] [Indexed: 10/17/2022] Open
Abstract
OBJECTIVE To report the rare case of gestational primary ovarian choriocarcinoma coexistent with intrauterine pregnancy, successfully treated with surgery and systemic chemotherapy. We also describe the utility of short tandem repeat (STR) genotyping in the diagnosis of choriocarcinoma. CASE REPORT A 38-year-old woman at 17 gestational weeks presented with an ovarian tumor rupture in the left ovary. Left salpingo-oophorectomy was performed and the patient was diagnosed with gestational ovarian choriocarcinoma via histopathology and STR genotyping. After artificial abortion, the patient underwent 8 cycles of chemotherapy. Abdominal hysterectomy was performed because of the presence of low levels of human chorionic gonadotropin and the tumor that developed behind the uterus. However, no viable choriocarcinoma cells were found in the residual tumor, suggesting that the patient achieved full remission. CONCLUSIONS Early detection is crucial in treating choriocarcinomas; thus, clinicians should consider the possibility of choriocarcinoma at the presence of an ovarian tumor during pregnancy. Gestational and non-gestational choriocarcinomas differ in prognosis and sensitivity to chemotherapy due to their different etiologies. Therefore, STR genotyping may be beneficial in predicting the patient's prognosis or selecting the appropriate regimen.
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Affiliation(s)
- Shizuka Sakurai
- Department of Obstetrics and Gynecology, Yokohama Municipal Citizen's Hospital, 1-2 Mitsuzawa Nishimachi Kanagawa-ku, Yokohama, Kanagawa, 221-0855, Japan
| | - Ryoko Asano
- Department of Obstetrics and Gynecology, Yokohama Municipal Citizen's Hospital, 1-2 Mitsuzawa Nishimachi Kanagawa-ku, Yokohama, Kanagawa, 221-0855, Japan.
| | - Megumi Furugori
- Department of Obstetrics and Gynecology, Yokohama Municipal Citizen's Hospital, 1-2 Mitsuzawa Nishimachi Kanagawa-ku, Yokohama, Kanagawa, 221-0855, Japan
| | - Hiroyuki Shigeta
- Department of Obstetrics and Gynecology, Yokohama Municipal Citizen's Hospital, 1-2 Mitsuzawa Nishimachi Kanagawa-ku, Yokohama, Kanagawa, 221-0855, Japan
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5
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Systematic review of fetal and placental metastases among pregnant patients with cancer. Cancer Treat Rev 2022; 104:102356. [DOI: 10.1016/j.ctrv.2022.102356] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 02/01/2022] [Accepted: 02/03/2022] [Indexed: 12/16/2022]
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Pessanha I, Heitor F, Furtado E, Campos AP, Gonçalves I. Long-term survival after choriocarcinoma transmitted by liver graft: A successful report in pediatric transplantation. Pediatr Transplant 2022; 26:e14135. [PMID: 34486207 DOI: 10.1111/petr.14135] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 08/07/2021] [Accepted: 08/25/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND LT is the standard of care for many pediatric liver disorders. Although long-term outcomes have improved, some rare complications such as transmission of occult donor tumors have been reported. CASE REPORT An adolescent diagnosed with tyrosinemia was submitted to LT from a previous healthy donor due to HCC. Almost 8 months after LT, the patient presented a nodular hepatic lesion. Clinically, he had mild weight loss, lower limb edema, and gynecomastia. Thorax CT found lesions in the left lung parenchyma, which showed no increased uptake in PET SCAN. Liver biopsy revealed a carcinoma with desmoplastic stroma. ISS was withdrawn, and palliative chemotherapy was started for presumptive HCC relapse. AFP remained normal, but HCG had reached unexpected values of 1984 IU/L. As we requested detailed information about the other organ recipients from the same donor, we found that one of them passed away due to disseminated tumor. Five months after the beginning of chemotherapy, the patient underwent resection of liver segments V and VI. Histological examination confirmed liver metastatic choriocarcinoma. At the time of writing, with 11 years of follow-up, the patient had sustained remission with no signs of relapse. DISCUSSION This case reports a diagnostic challenge in an adolescent with a particular unique background and a very rare pattern of tumor transmission. The authors aim to highlight the risk of cancer-bearing organs reveled post-LT and to testimony the experience of the successful outcome after a choriocarcinoma transmitted by liver graft.
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Affiliation(s)
- Inês Pessanha
- Serviço de Cirurgia Pediátrica e Queimados, Hospital Pediátrico de Coimbra, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Fátima Heitor
- Serviço de Oncologia Pediátrica, Hospital Pediátrico de Coimbra, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Emanuel Furtado
- Unidade de Hepatologia e Transplantação Hepática de Adultos, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - António Pedro Campos
- Unidade de Cuidados Respiratórios e Nutricionais, Hospital Dona Estefânia, Centro Hospitalar Lisboa Central, Lisboa, Portugal
| | - Isabel Gonçalves
- Unidade de Hepatologia e Transplantação Hepática Pediátrica, Hospital Pediátrico de Coimbra, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
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Girolami I, Neil D, Segev DL, Furian L, Zaza G, Boggi U, Gambaro G, De Feo T, Casartelli-Liviero M, Cardillo M, Lombardini L, Zampicinini L, D'Errico A, Eccher A. Discovered cancers at postmortem donor examination: A starting point for quality improvement of donor assessment. Transplant Rev (Orlando) 2021; 35:100608. [PMID: 33647551 DOI: 10.1016/j.trre.2021.100608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 02/07/2021] [Accepted: 02/08/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND clinical and imaging investigations allow a detailed assessment of an organ donor, but a quota of cancer still elude detection. Complete autopsy of donors is even less frequently performed, due to economic issues and increasing availability of high-quality imaging. The aim of this study is to gather evidence from the literature on donor malignancy discovered at autopsy following organ donation and to discuss the utility and limitations of autopsy practice in the field of transplantation. METHODS A systematic search according to PRISMA guidelines was carried out in Pubmed and Embase databases until September 2020 to select articles with reporting of cancer discovered in a donor at postmortem examination. Cancer discover in not-transplant setting were excluded. A descriptive synthesis was provided. RESULTS Of 7388 articles after duplicates removal, 56 were included. Fifty-one studies reported on complete autopsy, while 5 dealt only with limited autopsy (prostate and central nervous system). The number of autopsies ranged between 1 and 246 with a total of 823 autopsies performed. The most frequent cancer discovered at autopsy was lymphoma (n = 13, 15%), followed by renal cell carcinoma (RCC) (n = 11, 13%), non-small cell lung cancer (NSCLC) (n = 10, 11%), melanoma (n = 10, 11%), choriocarcinoma (n = 6, 7%) and glioblastoma (GBM) (n = 6, 7%). CONCLUSIONS Lymphoma and melanoma are still difficult-to-detect cancers both during donor investigation and at procurement, whilst prostate cancer and choriocarcinoma are almost always easily detected nowadays thank to blood markers and clinical examination. There have been improvements with time in pre-donation detection procedures which are now working well, particularly when complete imaging investigations are performed, given that detection rate of CT/MRI is high and accurate. Autopsy can play a role to help to establish the correct donor management pathways in case of cancer discover. Furthermore, it helps to better understand which cancers are still eluding detection and consequently to refine guidelines' assessment procedures.
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Affiliation(s)
- Ilaria Girolami
- Division of Pathology, Central Hospital Bolzano, Bolzano, Italy
| | - Desley Neil
- Department of Cellular Pathology, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Dorry Lidor Segev
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Lucrezia Furian
- Kidney and Pancreas Transplantation Unit, Department of Surgical, Oncological and Gastroenterological Sciences, University and Hospital Trust of Padua, Padua, Italy
| | - Gianluigi Zaza
- Renal Unit, University and Hospital Trust of Verona, Verona, Italy
| | - Ugo Boggi
- Division of General and Transplant Surgery, University of Pisa, Pisa, Italy
| | - Giovanni Gambaro
- Renal Unit, University and Hospital Trust of Verona, Verona, Italy
| | - Tullia De Feo
- North Italy Transplant Program, Coordinamento Trapianti, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Cà Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Marilena Casartelli-Liviero
- Neurosurgery and Intensive Care Unit, Department of Surgical Science, University and Hospital Trust of Verona, Verona, Italy
| | | | | | - Laura Zampicinini
- Neurosurgery and Intensive Care Unit, Department of Surgical Science, University and Hospital Trust of Verona, Verona, Italy
| | - Antonietta D'Errico
- Pathology Unit, University of Bologna, IRCCS Policlinico St. Orsola-Malpighi Hospital, Bologna, Italy
| | - Albino Eccher
- Department of Pathology and Diagnostics, University and Hospital Trust of Verona, Verona, Italy.
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8
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de Queiroz Moura D, Rawache R, Garcia MFG, Vasconcelos NF, Santos P, Coelho GR, Luis da Paz Santos T, Reis da Rocha Filho D, Leite da Silva S, Barbosa de Almeida ER, Fernandes PFCBC, Cerqueira JB, Parente Garcia JH, Costa de Oliveira CM. Donor Choriocarcinoma Transmission From Solid Organ Transplantation: A Case Report. Transplant Proc 2020; 53:1345-1349. [PMID: 33384179 DOI: 10.1016/j.transproceed.2020.10.034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 10/30/2020] [Indexed: 11/18/2022]
Abstract
Transplantation of any organ has some inherent risk of disease transmission, such as infection and malignancy. The present study aims to describe 2 cases of choriocarcinoma transmission after kidney and liver transplantation originating from the same patient. The donor was a 17-year-old woman who died of cerebral hemorrhage. Both organ recipients died of metastatic choriocarcinoma few months after the transplantation, within days after starting chemotherapy. Retrospective hCG (human chorionic gonadotropin hormone) analysis in donor's blood stored at the time of donation had a result of 9324 mIU/mL. Despite its rarity, clinicians should be aware of the risk of transplant-related choriocarcinoma from female donors in childbearing age. In some cases, hCG dosage should be performed before donation.
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Affiliation(s)
- Daniela de Queiroz Moura
- Kidney Transplantation Service at Walter Cantídio University Hospital, Fortaleza (CE), Brazil; Federal University of Ceará - Fortaleza (CE), Fortaleza (CE), Brazil.
| | - Ramon Rawache
- Federal University of Ceará - Fortaleza (CE), Fortaleza (CE), Brazil; Liver Transplantation Service at Walter Cantídio University Hospital, Fortaleza, (CE), Brazil
| | | | | | - Priscila Santos
- Federal University of Ceará - Fortaleza (CE), Fortaleza (CE), Brazil
| | - Gustavo Rego Coelho
- Federal University of Ceará - Fortaleza (CE), Fortaleza (CE), Brazil; Liver Transplantation Service at Walter Cantídio University Hospital, Fortaleza, (CE), Brazil
| | - Thiago Luis da Paz Santos
- Kidney Transplantation Service at Walter Cantídio University Hospital, Fortaleza (CE), Brazil; Federal University of Ceará - Fortaleza (CE), Fortaleza (CE), Brazil
| | - Duílio Reis da Rocha Filho
- Kidney Transplantation Service at Walter Cantídio University Hospital, Fortaleza (CE), Brazil; Federal University of Ceará - Fortaleza (CE), Fortaleza (CE), Brazil
| | - Sonia Leite da Silva
- Kidney Transplantation Service at Walter Cantídio University Hospital, Fortaleza (CE), Brazil; Federal University of Ceará - Fortaleza (CE), Fortaleza (CE), Brazil
| | - Eliana Regia Barbosa de Almeida
- Kidney Transplantation Service at Walter Cantídio University Hospital, Fortaleza (CE), Brazil; Federal University of Ceará - Fortaleza (CE), Fortaleza (CE), Brazil
| | - Paula F C B C Fernandes
- Kidney Transplantation Service at Walter Cantídio University Hospital, Fortaleza (CE), Brazil; Federal University of Ceará - Fortaleza (CE), Fortaleza (CE), Brazil
| | - João Batista Cerqueira
- Kidney Transplantation Service at Walter Cantídio University Hospital, Fortaleza (CE), Brazil; Federal University of Ceará - Fortaleza (CE), Fortaleza (CE), Brazil
| | - José Huygens Parente Garcia
- Federal University of Ceará - Fortaleza (CE), Fortaleza (CE), Brazil; Liver Transplantation Service at Walter Cantídio University Hospital, Fortaleza, (CE), Brazil
| | - Claudia Maria Costa de Oliveira
- Kidney Transplantation Service at Walter Cantídio University Hospital, Fortaleza (CE), Brazil; Federal University of Ceará - Fortaleza (CE), Fortaleza (CE), Brazil
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Pang L, Ma XX. Choriocarcinoma with lumbar muscle metastases: A case report. World J Clin Cases 2020; 8:5036-5041. [PMID: 33195679 PMCID: PMC7642570 DOI: 10.12998/wjcc.v8.i20.5036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 06/18/2020] [Accepted: 08/31/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Choriocarcinoma is a highly malignant trophoblastic tumor that presents with early symptoms similar to those of an ectopic pregnancy. Here we present a patient with suspected ectopic pregnancy diagnosed by laparoscopic surgery in our hospital. The patient was found to have choriocarcinoma that had metastasized to the lumbar muscle and presented with symptoms similar to those of an ectopic pregnancy.
CASE SUMMARY The patient was a 34-year-old female who complained of amenorrhea lasting 53 d, 7 d of right lower back pain, and 3 d of right lower abdominal pain. Transvaginal ultrasonography revealed the absence of a gestational sac in the uterus and a mass in the left adnexa. After 6 d of re-examination, ultrasound and computed tomography (CT) examination were performed on the mass located in the left adnexa area. We also noted that the patient’s serum β-human chorionic gonadotropin (hCG) level was increased. Considering an ectopic pregnancy, we performed a laparoscopy and hysteroscopy. During the operation, a left ovarian mixed echogenic mass approximately 2.5 cm × 2.0 cm with no villous tissue was found. Postoperative levels of serum hCG continued to increase. Lung CT examination showed lung nodules. Both CT and magnetic resonance imaging showed a mixed echogenic mass in the lumbar muscle. Considering lumbar metastasis of choriocarcinoma, six courses of cisplatin, dactinomycin, and etoposide chemotherapy were given after surgery. The patient’s serum β-hCG level decreased to normal and the mixed echogenic mass in the lumbar muscle decreased in size after the fifth course of chemotherapy. All symptoms subsequently disappeared after treatment.
CONCLUSION In summary, lumbar metastasis from choriocarcinoma is extremely rare. Appropriate chemotherapy can successfully treat these metastasized tumors.
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Affiliation(s)
- Li Pang
- Department of Obstetrics and Gynecology, Shengjing Hospital Affiliated to China Medical University, Shenyang 110004, Liaoning Province, China
| | - Xiao-Xin Ma
- Department of Obstetrics and Gynecology, Shengjing Hospital Affiliated to China Medical University, Shenyang 110004, Liaoning Province, China
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Eccher A, Girolami I, Motter JD, Marletta S, Gambaro G, Momo REN, Nacchia F, Donato P, Boschiero L, Boggi U, Lombardini L, Cardillo M, D'Errico A, Neil D, Segev DL, Zaza G. Donor-transmitted cancer in kidney transplant recipients: a systematic review. J Nephrol 2020; 33:1321-1332. [PMID: 32535833 PMCID: PMC7701067 DOI: 10.1007/s40620-020-00775-4] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Accepted: 06/06/2020] [Indexed: 02/07/2023]
Abstract
The transmission of cancer from a donor organ is a rare event but has important consequences. Aim of this systematic review was to summarize all the published evidence on cancer transmission in kidney recipients. We reviewed published case reports and series describing the outcome of recipients with donor-transmitted cancer until August 2019. A total of 128 papers were included, representing 234 recipients. The most common transmitted cancers were lymphoma (n = 48, 20.5%), renal cancer (42, 17.9%), melanoma (40, 17.1%), non-small cell lung cancer (n = 13, 5.6%), neuroendocrine cancers comprising small cell lung cancer (n = 11, 4.7%) and choriocarcinoma (n = 10, 4.3%). There was a relative lack of glioblastoma and gastrointestinal cancers with only 6 and 5 cases, respectively. Melanoma and lung cancer had the worst prognosis, with 5-years overall survival of 43% and 19%, respectively; while renal cell cancer and lymphomas had a favorable prognosis with 5-years overall survival of 93 and 63%, respectively. Metastasis of cancer outside the graft was the most important adverse prognostic factor. Overall reporting was good, but information on donors' cause of death and investigations at procurement was often lacking. Epidemiology of transmitted cancer has evolved, thanks to screening with imaging and blood tests, as choriocarcinoma transmission have almost abolished, while melanoma and lymphoma are still difficult to detect and prevent.
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Affiliation(s)
- Albino Eccher
- Pathology Unit, Department of Pathology and Diagnostics, University and Hospital Trust of Verona, P.le Stefani n. 1, 37126, Verona, Italy.
| | - Ilaria Girolami
- Pathology Unit, Department of Pathology and Diagnostics, University and Hospital Trust of Verona, P.le Stefani n. 1, 37126, Verona, Italy
| | | | - Stefano Marletta
- Pathology Unit, Department of Pathology and Diagnostics, University and Hospital Trust of Verona, P.le Stefani n. 1, 37126, Verona, Italy
| | - Giovanni Gambaro
- Renal Unit, University and Hospital Trust of Verona, Verona, Italy
| | | | - Francesco Nacchia
- Department of Surgical Sciences, Kidney Transplant Center, University and Hospital Trust of Verona, Verona, Italy
| | - Paola Donato
- Department of Surgical Sciences, Kidney Transplant Center, University and Hospital Trust of Verona, Verona, Italy
| | - Luigino Boschiero
- Department of Surgical Sciences, Kidney Transplant Center, University and Hospital Trust of Verona, Verona, Italy
| | - Ugo Boggi
- Division of General and Transplant Surgery, University of Pisa, Pisa, Italy
| | - Letizia Lombardini
- National Transplant Center, Italian National Institute of Health, Rome, Italy
| | - Massimo Cardillo
- National Transplant Center, Italian National Institute of Health, Rome, Italy
| | - Antonietta D'Errico
- Pathology Unit, S. Orsola-Malpighi University Hospital of Bologna, Bologna, Italy
| | - Desley Neil
- Department of Histopathology, University Hospital Birmingham, National Health Service Foundation Trust, Birmingham, UK
| | - Dorry Lidor Segev
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MA, USA
| | - Gianluigi Zaza
- Renal Unit, University and Hospital Trust of Verona, Verona, Italy
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Kaur B, Sebire NJ. Gestational trophoblastic tumours and non-neoplastic trophoblastic lesions: morphology and immunocytochemistry to refine the diagnosis. ACTA ACUST UNITED AC 2019. [DOI: 10.1016/j.mpdhp.2018.12.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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12
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Yu P, Diao W, Jiang X. A Successfully Treated Metastatic Choriocarcinoma Coexistent With Pregnancy: A Case Report of a 4-Year Follow-Up. Medicine (Baltimore) 2016; 95:e3505. [PMID: 27227917 PMCID: PMC4902341 DOI: 10.1097/md.0000000000003505] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Gestational choriocarcinoma ended with a successful parturition is extremely rare, especially in cases where multiple metastases occurred.A 29-year-old Chinese primigravida was admitted with vaginal bleeding at 32 gestational week, and diagnosed with gestational choriocarcinoma with vaginal, pulmonary, and cerebral metastasis after pathological, and imaging examination. At 33 gestational week, a healthy infant was delivered by cesarean section. Although no evidence of choriocarcinoma or any other forms of gestational trophoblastic diseases was found in the placenta and uterine curettages, the patient was given 7 cycles of postpartum chemotherapy. Her serum beta-human chorionic gonadotropin level fell to the normal range, and the metastatic lesions reduced. The baby is still free from diseases, and the patient reports no clinical manifestation 4 years after the hospital discharge.Despite its rapid metastases and complications, gestational choriocarcinoma still can be successfully treated by postpartum chemotherapy with the least delay.
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Affiliation(s)
- Panxi Yu
- From Department No. 16 (PY), Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; Department of Respiratory Medicine (WD), Peking University Third Hospital, Beijing, China; and Department of Obstetrics and Gynecology (PY, WD and XJ), The First Affiliated Hospital of Ji-nan University, Guangzhou, China
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Liu H, Xiao YD, Peng SP, Zhou SK, Liu J. Pituitary metastasis of choriocarcinoma: A case report. Oncol Lett 2016; 11:1517-1520. [PMID: 26893772 DOI: 10.3892/ol.2016.4088] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Accepted: 06/03/2015] [Indexed: 01/09/2023] Open
Abstract
Choriocarcinoma is an aggressive obstetric or gynecological neoplasm with a high malignant potential. It is a form of gestational trophoblastic disease and often secondary to hydatidiform mole, and intrauterine or ectopic pregnancy. Choriocarcinoma has a proclivity to metastasize to the lung, vagina, pelvis or liver in over 50% of patients, which always occurs in the early stage of the disease. With an appropriate amount of chemotherapy, the tumor may be treated effectively. However, pituitary metastasis of choriocarcinoma is extremely rare. To the best of our knowledge, no cases of choriocarcinoma metastasizing to the pituitary have been cited previously. Here, we report a case of choriocarcinoma that presented with pituitary metastasis.
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Affiliation(s)
- Huan Liu
- Department of Radiology, The Second Xiangya Hospital of Central South University, Changsha, Hunan 410011, P.R. China
| | - Yu-Dong Xiao
- Department of Radiology, The Second Xiangya Hospital of Central South University, Changsha, Hunan 410011, P.R. China
| | - Shu-Ping Peng
- Department of Radiology, The Second Xiangya Hospital of Central South University, Changsha, Hunan 410011, P.R. China
| | - Shun-Ke Zhou
- Department of Radiology, The Second Xiangya Hospital of Central South University, Changsha, Hunan 410011, P.R. China
| | - Jun Liu
- Department of Radiology, The Second Xiangya Hospital of Central South University, Changsha, Hunan 410011, P.R. China
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Organ transplantation from donors (cadaveric or living) with a history of malignancy: Review of the literature. Transplant Rev (Orlando) 2014; 28:169-75. [DOI: 10.1016/j.trre.2014.06.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2013] [Revised: 03/15/2014] [Accepted: 06/11/2014] [Indexed: 12/11/2022]
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15
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Desai R, Neuberger J. Donor transmitted and de novo cancer after liver transplantation. World J Gastroenterol 2014; 20:6170-6179. [PMID: 24876738 PMCID: PMC4033455 DOI: 10.3748/wjg.v20.i20.6170] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2013] [Revised: 12/02/2013] [Accepted: 01/05/2014] [Indexed: 02/06/2023] Open
Abstract
Cancers in solid organ recipients may be classified as donor transmitted, donor derived, de novo or recurrent. The risk of donor-transmitted cancer is very low and can be reduced by careful screening of the donor but cannot be abolished and, in the United Kingdom series is less than 0.03%. For donors with a known history of cancer, the risks will depend on the nature of the cancer, the interventions given and the interval between diagnosis and organ donation. The risks of cancer transmission must be balanced against the risks of death awaiting a new graft and strict adherence to current guidelines may result increased patient death. Organs from selected patients, even with high-grade central nervous system (CNS) malignancy and after a shunt, can, in some circumstances, be considered. Of potential donors with non-CNS cancers, whether organs may be safely used again depends on the nature of the cancer, the treatment and interval. Data are scarce about the most appropriate treatment when donor transmitted cancer is diagnosed: sometimes substitution of agents and reduction of the immunosuppressive load may be adequate and the impact of graft removal should be considered but not always indicated. Liver allograft recipients are at increased risk of some de novo cancers, especially those grafted for alcohol-related liver disease and hepatitis C virus infection. The risk of lymphoproliferative disease and cancers of the skin, upper airway and bowel are increased but not breast. Recipients should be advised to avoid risk behavior and monitored appropriately.
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Abstract
Several criteria are used to differentiate between standard and extended allograft donors. These criteria include deceased after cardiac death, advanced donor age, steatosis, previous malignancy in the donor, hepatitis C virus-positive allografts, human T-cell lymphotropic virus-positive allografts, active infections in the donor, high-risk donors, split liver transplantations, and living donor liver transplantations. Review of the literature can lead each practitioner to incorporate extended criteria donors into their transplant program, thereby individualizing the use of these allografts, increasing the donor pool, and decreasing overall waitlist mortality.
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Affiliation(s)
- Theresa R Harring
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX 77030, USA.
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