Case report: Glial cell tumour (glioblastoma) (1990)

Record number: 
MPHO Type: 
Estimated frequency: 
Most recent risk assessment for astrocytoma and glioblastoma (Council of Europe, 2022): Potential donors with pilocytic astrocytoma (WHO grade I) may be considered for organ donation with minimal risk of transmission. Extraneural 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 transformation into a more aggressive malignancy can be ruled out. Since astrocytomas tend to relapse with a histologically higher grade of malignancy, new histological examinations to regrade the tumour should be performed where relapse occurs. If the tumour 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 extraneural metastases of anaplastic astrocytomas and glioblastoma are rare, but such metastases have been observed, and seem to 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 (WHO grade IV) are considered intermediate to high risk for transmission, depending on 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: 
9 months
Alerting signals, symptoms, evidence of occurrence: 
Abdominal (right upper quadrant) pain, severe headaches, nausea & vomiting. Lesions in liver graft by imaging. Biopsy compatible with poorly differentiated pleomorphic neoplasia, immunohistochemistry consistent with a tumor of neural origin (similar to donor´s tumor). Laparotomy showed extensive tumor involvement of viscera and infrahepatic structures.
Demonstration of imputability or root cause: 
Condition known in the donor, diagnosed before donation of malignant glial neoplasia infiltrating pons, pituitary, spinal leptomeninges and spinal cord. Described as glioblastoma in Discussion. No other risk factor. Two kidneys and heart also transplanted, with no other recipient affected. Similar histological appearance and patterns of immunocytochemical staining in donor´s and liver recipient's tumor.
Imputability grade: 
3 Definite/Certain/Proven
Groups audience: 
Suggest new keywords: 
Case Report
Deceased donor
Liver transplant
Histologic analysis
Central nervous system
Astrocytoma/glioblastoma multiform E. (WHO grade 4)
Reduction of immunosuppression
Patient death
Suggest references: 
Expert comments for publication: 
Uncommon example of transmission of glioblastoma without typical risk factors described in literature. Extensive infiltration of CNS including spinal cord and spinal leptomeninges in the donor is noted.