Case report: Donor transmitted angiosarcoma presumed derived from donor CNS hemangioma and transmitted by lung transplantation (2022).

This patient underwent bilateral lung transplant with organs from a 44 year old woman who died following complications of a neurosurgical procedure for previously biopsy-proven cerebral hemangioma. The recipient tumors were clearly shown to be of donor origin. The problematic area lies in understanding the underlying pathogenesis of the events. The authors suggest that the cerebral lesion could have represented a precursor lesion leading to the multifocal recipient disease. They do show similar molecular features between the malignant ovarian and earlier indeterminate pulmonary vascular lesions. A low-power photomicrograph of the original (pretransplant) donor CNS lesion appears to show a cavernous hemangioma; unfortunately, no molecular studies are available. Assuming that their interpretation is correct, this would imply that benign circulating cells from the hemangioma deposited in the lung and underwent eventual malignant transformation. A separate possibliity is that the initial pulmonary allograft lesion represented a separate lesion that was so small as to be undetectable at transplant. (The lesion was not FDG-avid on initial examination). In either case, it does seem that a fully developed malignant neoplasm was not present in the donor at time of transplant and that this represents a posttransplant evolution of tumor development from donor cells, i.e., donor-derived neoplasm. One lesson of this report, as noted by the authors, is that "donor origin of tumors detected in solid organ transplant recipients should always be suspected in case of a uncommon disease course or histology".