Case report: Carcinoma of unknown primary site with multiple transmissions (2017)

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Record number: 
Adverse Occurrence type: 
MPHO Type: 
Estimated frequency: 
N/A: The histopathologic origin of the donor-transmitted tumor was not determined.
Time to detection: 
100 days after transplantation
Alerting signals, symptoms, evidence of occurrence: 
The patient presented with abdominal pain and rectal bleeding. Evaluation showed elevated creatinine and LDH. Chest X ray showed multiple lung opacities and CT showed lung lesions, renal graft involvement, and widespread adenopathy. CEA, CA125 and beta-HCG (slight) were elevated. A biopsy of the allograft kidney showed poorly differentiated adenocarcinoma of possible gastric, pulmonary, or gynecologic origin. Investigation showed that additional recipients from the donor (1 kidney, 1 liver) also developed tumor.
Demonstration of imputability or root cause: 
Karyotype of the tumor showed XX (female donor) origin in this XY male recipient; Microsatellite DNA PCR analysis showed donor origin.
Imputability grade: 
3 Definite/Certain/Proven
Groups audience: 
Suggest new keywords: 
Case Report
Deceased donor
DBD/donation after brain death
Kidney transplant
Kidney recipient
Kidney transplantation
Liver transplant
Liver recipient
Liver transplantation
Carcinoma of unknown primary site
Cytogenetic analysis
Karyotype analysis
XY chromosomes
DNA typing
Microsatellite analysis
Therapy discussed
Suggest references: 
Baudoux TER, Gastaldello K, Rorive S, Hamade A, Broeders N, Nortier JL. Donor Cancer Transmission in Kidney Transplantation. Kidney Int Rep. 2017;2(2):134-7.
Please also clone record for MPHO type->liver --> OK (EP) First review MN 5/9/22 Second review MCS 6/3/22
Expert comments for publication: 
The donor is described as an unrelated brain-dead donor without additional details. The patient underwent allograft nephrectomy followed by cessation of immunosuppression and chemotherapy and went into remission with no evidence of tumor 20 months following the end of chemotherapy. The other recipients underwent partial (liver) or complete (kidney) graft resection; additional followup is not provided. The authors follow with a discussion focusing on an overview of tumor transmission risks.