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Adverse Occurrence type:
(Council of Europe, 2018): Extra-neural metastases by histologically benign meningiomas are very rare. Organs from potential donors with these types of tumours have a minimal risk of transmission. Anaplastic or malignant meningiomas (WHO grade III) are more aggressive meningeal tumours that occasionally can be associated with extra-neural metastases. Organs from potential donors with these tumours are considered low to intermediate risk if no risk factors are present. The transmission risk of anaplastic or malignant meningiomas is increased (high risk) in cases with previous interventions such as tumour resection, ventriculo-peritoneal/-atrial drainage and/or cranial chemo-/radiotherapy.
Time to detection:
Alerting signals, symptoms, evidence of occurrence:
Declining graft function, with kidney biopsy compatible with epitheliod sarcoma determined to represent donor transmitted malignant meningioma (initially diagnosed in donor as Grade II astrocytoma). Transplantectomy performed, laparotomy revealing peritoneal cavity invaded by multiple small metastasis. Two liver metastasis shown by CT and MRI.
Demonstration of imputability or root cause:
Condition known in the donor. Histology and immunohistochemical staining of the kidney biopsy showed a complete homology with the brain tissue biopsy of the donor, initially diagnosed of astrocytoma grade II. HLA-DR typing of the kidney graft tumour unequivocally showed donor origin. It was concluded that the recipient had developed a metastatic disease of a malignant meningioma in the transplanted kidney. Alpha interferon given with complete remission at 1 year followup.
Suggest new keywords:
CNS tumor, other or type not specified
Bosmans JL, Ysebaert D, DeCock AM, Hauben E, Muylle L, Schrijvers D, Van Marck E, Eyskens E, De Broer ME. Interferon-alpha and the cure of metastasis of a malignant meningioma in a kidney allograft recipient: A case report. Transplant Proc 29, 838. 1997.
A new review is necessary - record unpublished (EP) Case report reviewed and pdf uploaded, OK to publish (MN)
Expert comments for publication:
This appears to be a unique report of donor transmission of malignant meningioma. Meningiomas are typically considered to be benign tumors that are not transmissible. Malignant meningioma is a recognized variant.