Status:
Ready to upload
Record number:
2279
Adverse Occurrence type:
MPHO Type:
Estimated frequency:
Most recent risk assessment for breast cancer (Council of Europe, 2022):
Newly diagnosed invasive breast cancer is an unacceptable risk for organ donation.
Breast cancer in the donor history: Organs from donors with invasive breast cancer might be accepted in selected cases after full treatment, complete remission and stringent follow-up for > 5 years, depending on the initial stage and E/P and HER2/neu receptor expression, always bearing in mind the risk of transmission due to possible late metastases. Breast cancer stage 1 (AJCC, 8th edition) with curative surgery and cancer-free period > 5 years seems to be associated with low to intermediate risk for transmission. All other invasive breast cancer stages are considered high-risk for transmission, independent of the presumed recurrence-free survival and treatment.
Time to detection:
5-6 years, depending on origin (one kidney transplant 5 years earlier, one 6 years earlier, both female donors)
Alerting signals, symptoms, evidence of occurrence:
This 74 year old male presented with lower abdominal pain and macrohematuria 5 years after his second kidney transplant. CT scan showed a 4-5 cm lesion in the native left kidney.
Demonstration of imputability or root cause:
Histologic examination revealed a lobular breast carcinoma, estrogen receptor-positive. Fluorescent in situ hybridization (FISH) for X and Y chromosomes showed female tumor origin in this male recipient. Both kidney donors were female.
Imputability grade:
3 Definite/Certain/Proven
Groups audience:
Keywords:
References:
Suggest new keywords:
Malignancy
Deceased donor
Kidney transplant
Breast Lobular adenocarcinoma
Breast Cancer
Therapy discussed
Case Report
FISH (fluorescence in situ hybridization)
Reference attachment:
Suggest references:
Cooper JM, Samueli B, Mazor E, Kian W, Goldvaser H, Ben-Arie G. Molecularly Confirmed Female Donor-Transmitted Lobular Breast Cancer to Male following Renal Transplantation. Pathobiology. 2023;90(1):63-68. doi: 10.1159/000524479. Epub 2022 May 2. PMID: 35500563.
Note:
Please add lobular adenocarcinoma into the Breast Malignancy section under harm to recipient ->Malignancy (and mark it for this case report) (I temporarily simply marked it as breast cancer, other, you can change that). -- OK (EP)
First review MN 3/23/24
Second review KM 7/1/24
Expert comments for publication:
This late onset tumor would typically be described as a donor-derived tumor. However, in this case it is assumed that small numbers of malignant breast carcinoma cells were transferred at the time of kidney transplant. The authors suggest that the male recipient did not provide a supportive microenvironment for this estrogen-positive tumor, accounting for the slow growth limited to the perinephric fat of the native kidney. Unfortunately, 5 other (female) recipients from these two kidney donors had previously expired, and no further information was available, including causes of death. The present recipient underwent native nephrectomy and received chemotherapy, and was without evidence of disease at 39 months followup. The authors suggest that the behavior of low-grade estrogen receptor-positive cancers may differ in men versus women, and would be worth investigating in terms of expanded criteria donors. One might also suggest that, under similar circumstances, it would be worth alerting any other recipients of organs from the same donor regarding the possibility of late-onset tumors of donor origin. In this case, no further information about the medical history of the two donors was available (including any information about previous breast cancer).