Case report: Transmission of Donor Germ cell tumor (Embryonal and Yolk Sac Carcinoma) by Heart Transplant (2021)

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Donor germ cell tumors are not considered in the Council of Europe recommendations. However, the presence of metastatic carcinoma in this donor could be considered a contraindication to transplant. Although the Council of Europe does not deal with germ cell cancer as a category it has more generalized guidelines for testicular and ovarian cancers, as well as CNS germ cell tumors. Testicular cancer: Most recent risk assessment for testicular cancer (Council of Europe, 2022): No literature exists regarding newly diagnosed testicular cancer and organ donation. Therefore, the highest caution is recommended. Testicular tumour in donor history: Given the good treatment response of testicular tumours in general and stage 1 tumours in particular, a stage 1 tumour with at least 5 years recurrence-free follow up is likely to be associated with minimal risk. Ovarian cancer: Most recent risk assessment for ovarian cancer (Council of Europe, 2022): Ovarian cancer is considered an unacceptable risk for organ donation. Ovarian cancer in the donor history: Treated ovarian cancer is considered high-risk for organ donation. Depending on initial stage, grade, therapy and time of recurrence-free survival (> 5 years), the risk category might decrease individually. CNS germ cell tumors: Most recent risk assessment for CNS germ cell tumors (Council of Europe, 2022): Organs from potential donors with mature teratomas represent a minimal risk of tumour transmission. Organs from donors with other germ cell tumours should be considered intermediate to high risk for tumour transmission, depending on the different international recommendations, which will be adjusted with increasing evidence. The transmission risk is further increased in cases with previous interventions such as tumour resection, ventriculo-¬peritoneal/-atrial drainage and/or cranial chemo-/radiotherapy.
Time to detection: 
3 months
Alerting signals, symptoms, evidence of occurrence: 
Tumor found on heart biopsy at 3 months; elevated AFP, beta-HCG found and radiology showed multiple pulmonary masses.
Demonstration of imputability or root cause: 
Metastatic germ cell tumor (embryonal carcinoma with component of yolk sac tumor) diagnosed in 20 year old donor after recipient operation started. Recipient underwent surveillance and endomyocardial biopsy at 3 months showed embryonal carcinoma;
Imputability grade: 
3 Definite/Certain/Proven
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Suggest new keywords: 
Case report
Deceased donor
Heart transplant
Embryonal cell carcinoma
Yolk sac tumor
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Suggest references: 
Marish I.F.J. Oerlemans, Gerard Groenewegen, Aryan Vink, Linda W. van Laake, Niels P. van der Kaaij, Nicolaas de Jonge, Donor-Derived Testicular Germ Cell Cancer in a Heart Transplant Recipient, JACC: CardioOncology, Volume 3, Issue 2, 2021, Pages 322-325.
MN first review 10/17/21 Note that this case is reported twice (see report 2148) CLFF second review 06/May/2022 (idenpendent read of article, same conclusions). Unfortunately point of no return in heart transplantation had been passed when donor malignancy became known. Secondly in CoE we should mention the association of LE and risk of malignancy with broad indication for whole body CT scan when possible (Discussion) 6/14/22: Removed the reference to choriocarcinoma, since that is not a germ cell tumor. MN
Expert comments for publication: 
An unfortunate case in which discovery of donor tumor was found at a time when it was too late to stop the transplant. Chemotherapy caused some regression, but the patient expired due to cardiac arrest. The authors note that the young donor had probable unprovoked thromboembolism and chest CT did not detect any abnormalities. They now do a full body CT under such circumstances since occult cancer can be seen in 5% of patients with unprovoked thromboembolism.