Case report: Glioblastoma multiforme (1998)

Condition known in the donor. Frontal lobe glioma removed 4 months before death with local recurrence and death following a second surgery. Two kidneys and liver were transplanted. No evidence of malignant disease in the two kidney recipients 2 months after transplantation. So only one recipient affected. Histopathological examination of the primary and recurrent brain tumour and of all metastatic lesions showed the classic features of glioblastoma multiforme (GBM). The primary GBM was the only lesion to express glial fibrillary acidic protein (GFAP). Loss of GFAP expression during disease progression coincided with the less differentiated histological appearance of the locally recurrent and metastatic lesions and is directly associated with glioma dissemination. Microsatellite DNA fingerprinting revealed identical allele patterns in all brain tumour and metastatic lesions, thus identifying all metastases as donor related. In addition, DNA sequencing of the p53 tumour suppressor gene showed a C→T transition changing aminoacids from histidine to tyrosine at codon 179 in all lesions. Alternatively spliced variants of the CD44 cell adhesion molecule expressed by both the recurrent brain tumour and its metastatic lesions were linked with the unusual metastatic phenotype of a GBM and, in addition, support the previously proposed metastasis model.