Case report: Glioblastoma transmitted by lung transplantation (2008)

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Record number: 
MPHO Type: 
Estimated frequency: 
(Council of Europe, 2018): Potential donors with pilocytic astrocytoma (WHO grade I) may be considered for organ donation with minimal risk of transmission. Extra-neural metastases from low grade astrocytomas (WHO grade II) are rare, and have been associated with resection and ventriculo-peritoneal shunts. In the absence of these risk factors the donor may be considered minimal risk. Risk may increase with the extent of performed interventions. A complete histological examination of the tumour should be performed so that areas of more aggressive malignancy are ruled out. Since astrocytomas have a tendency to relapse with a histologically higher grade of malignancy, new histological examinations should be performed where relapse occurs to regrade the tumour. If the tumor co-exists with histological areas of greater malignancy or is very invasive locally, it should be considered high grade and will be associated with an increased risk of transmission. Spontaneous extra-neural metastases of anaplastic astrocytomas and glioblastoma multiforme are rare, but have been observed, and occur more frequently when associated with prior surgical treatment and/or ventriculo-peritoneal drainage, or chemo-/radiotherapy. Potential donors with anaplastic astrocytomas (WHO grade III) can be accepted as organ donors. Transmission risk is considered low to intermediate for tumours without any risk factors. Potential donors with glioblastoma multiforme (WHO grade IV) are considered intermediate to high risk for transmission depending on the different national recommendations, which are expected to be adjusted with increasing evidence. The transmission risk is increased (high risk) in all cases with previous interventions such as tumour resection, ventriculo-peritoneal/-atrial drainage and/or cranial chemo-/radiotherapy.
Time to detection: 
15 months after double lung-TX the recipient deflopde cough and dyspnoe. A CT-scan showed bilateral round opacities, pleuarl effuision and mediastinal adenopathy (PET: reactive too). At this time it was known, that the donor has died of an ICB which was casued by an glioblastoma multiforme (GFAP+++, Autopsy, no filiae, no patholgies outside brain), the lung recipient did not want to have retransplantation. Within further work up initial bronchoscopic.was done for suspected PTLD, then CT-guided biopsy of SOL and mediastinoscopy revealed poorly differntiated Carcinoma, containing glial fibrillry acid protein and CD56 plus other imunohistopathology results. Taken togehter all data this resulted in diagnosis of a GBM. Note, imaging and search for brain tumor in recipient was without result (no pathologies identified). Since the recipient deteriorated chemotherapy was not initiated and the recipient passed 2 months later away. The heart recipient, the liver recipient, the pancreas-kidney recipient did not evolve GBM, the other kidney recipient had removed the graft after information about the autopsy result of the donor (no malignancy)
Alerting signals, symptoms, evidence of occurrence: 
CT performed following cough and dyspnea showed multiple pulmonary opacities, pleural effusion and mediastinal adenopathy. Biopsy was consistent with glioblastoma.
Demonstration of imputability or root cause: 
Workup required immunohistochemistry to obtain correct diagnoss (originally considered as carcinoma). Prior autopsy of donor (47 year old make with acute intracranial hemorrhage) showed glioblastoma.
Imputability grade: 
3 Definite/Certain/Proven
Groups audience: 
Suggest new keywords: 
Case Report
Deceased donor
Lung transplant
Lung recipient
Histopathological examination
Astrocytoma/glioblastoma multiform E. (WHO grade 4)
Therapy discussed
Suggest references: 
Chen H, Shah AS, Girgis RE, Grossman SA. Transmission of glioblastoma multiforme after bilateral lung transplantation. J Clin Oncol. 2008 Jul 1;26(19):3284-5. doi: 10.1200/JCO.2008.16.3543. PMID: 18591565. Fatt MA, Horton KM, Fishman EK. Transmission of metastatic glioblastoma multiforme from donor to lung transplant recipient. J Comput Assist Tomogr. 2008 May-Jun;32(3):407-9. doi: 10.1097/RCT.0b013e318076b472. PMID: 18520546. Nauen DW, Li QK. Cytological diagnosis of metastatic glioblastoma in the pleural effusion of a lung transplant patient. Diagn Cytopathol. 2014 Jul;42(7):619-23. doi: 10.1002/dc.22993. Epub 2013 Apr 3. PMID: 23554289.
Uploaded MN 5/8/22; note probably the same patient reported in record 2169 + 2175: see record 2177 (record 2177+2175+2169 are the same case) first review CLFF 5/16/22 Second review MN 1/28/23
Expert comments for publication: 
Interesting case with GBM manifested only in the lung recipient. No tumor present in recipients of heart, liver, pancreas and kidneys of same donor. The authors suggest that although the rate of transmission of these tumors is low, lung and liver recipients may be at higher risk than recipients of other organs. It is necessary to consider the diagnosis of extracranial spread of CNS malignancy in appropriate cases, since the lesion can be misinterpreted as carcinoma or sarcoma unless appropriate workup is performed (one of the reviewers knows a similiar case with lung manifestation and no GBM in any other recipient, initially misinterpreted as sarcoma - case unpublished). The patient in this case refused retransplantation and rapidly underwent clinical deterioration leading to death in 2 months. Treatment was not possible due to severe hypoxia and pleural effusion. Two additional publications of this case (not included in the NOTIFY library) focus on the radiologic manifestations (M. A. Fatt, K. M. Horton and E. K. Fishman, Transmission of metastatic glioblastoma multiforme from donor to lung transplant recipient; J Comput Assist Tomogr 2008 Vol. 32 Issue 3 Pages 407-9) and the cytologic diagnosis (D. W. Nauen and Q. K. Li, Cytological diagnosis of metastatic glioblastoma in the pleural effusion of a lung transplant patient; Diagn Cytopathol 2014 Vol. 42 Issue 7 Pages 619-23).