Status:
Ready to upload
Record number:
1898
Adverse Occurrence type:
MPHO Type:
Estimated frequency:
(Council of Europe, 2022): To provide valid histological staging, complete tumour resection (R0) is required for acceptance of all organs; additionally, tumour-free margins are a prerequisite for transplant of the affected kidney. Paraffin section is superior to frozen section for the assessment of such biopsies. The contralateral kidney should always be examined for synchronous RCC (5 % of patients). RCC < 1 cm (stage T1a AJCC 8th edn) and WHO/ISUP grade I/II (Fuhrman grade I/II) can be considered minimal-risk for transmission; RCC 1-4 cm (stage T1a AJCC 8th edn) and WHO/ISUP grade I/II (Fuhrman grade I/II) are considered low-risk; RCC > 4-7 cm (stage T1b AJCC 8th edn) and WHO/ISUP grade I/II (Fuhrman grade I/II) are considered intermediate-risk; RCC > 7 cm (stage T2 AJCC 8th edn) and WHO/ISUP grade I/II (Fuhrman grade I/II) are considered high-risk; RCC with extension beyond the kidney (stages T3/T4 AJCC 8th edn) is considered a contraindication to transplant; All RCC with WHO/ISUP grade III/IV (Fuhrman grade III/IV) are considered high-risk for transmission; Contralateral kidneys and other organs that are un¬involved in carcinoma are considered to represent minimal risk for transplantation when the RCC in the involved kidney is 4 cm or less and WHO/ISUP grade I-II. In all cases, follow-up surveillance is desirable.
RCC in the donor history: The transmission risk of treated RCC depends on the histological type of tumour [159] and its recurrence-free follow-up period. In general, in the first 5 years after initial diagnosis, risk categories correspond to those stated above (RCC diagnosed during donor procurement) if there is no suspicion of tumour recurrence in the donor. After this time, the risk of advanced stages may decrease.
Time to detection:
11 years
Alerting signals, symptoms, evidence of occurrence:
Radiologic study performed 11 years after transplant when the patient presented with hematuria and symptoms related to acute gastroenteritis. Allograft had failed previously due to noncompliance and the patient had recently returned to hemodialysis.
Demonstration of imputability or root cause:
1.8 cm mass in allograft found 11 years after transplant was presumed to represent de novo postttransplant malignancy. No evidence of tumor elsewhere.
Imputability grade:
0 Excluded
Groups audience:
Keywords:
Suggest new keywords:
Case report
Kidney transplant
Renal cell carcinoma
Chromophobe carcinoma
Deceased donor
Histologic analysis
Immunohistochemistry
Allograft nephrectomy
Reference attachment:
Suggest references:
Alharbi A, Al Turki MS, Aloudah N, Alsaad KO. Incidental Eosinophilic Chromophobe Renal Cell Carcinoma in Renal Allograft. Case Rep Transplant. 2017;2017:4232474.
Note:
Reviewed 7/26/19; OK to upload. MN
Expert comments for publication:
This small asymptomatic tumor was discovered incidentally during evaluation for symptoms related mainly to gastroenteritis. No specific donor-related studies were performed but the long latency period and small size make this likely to represent a tumor that arose posttransplant. Following allograft nephrectomy, the patient did well with no evidence of tumor during a 55 month follow period. Chromophobe renal carcinoma is an uncommon type and thought to have a better prognosis than standard RCC. Large tumor size and sarcomatoid differentiation are associated with a worse prognosis. A small series of 5 case reports of such tumors in renal allografts is included in this paper, with onset times ranging from 5-15 years posttransplant. Followup available for 3 patients showed no evidence of tumor-related mortality.