Status:
Ready to upload
Record number:
1901
Adverse Occurrence type:
MPHO Type:
Estimated frequency:
(Council of Europe, 2022): To provide valid histological staging, complete tumour resection (R0) is required for acceptance of all organs; additionally, tumour-free margins are a prerequisite for transplant of the affected kidney. Paraffin section is superior to frozen section for the assessment of such biopsies. The contralateral kidney should always be examined for synchronous RCC (5 % of patients). RCC < 1 cm (stage T1a AJCC 8th edn) and WHO/ISUP grade I/II (Fuhrman grade I/II) can be considered minimal-risk for transmission; RCC 1-4 cm (stage T1a AJCC 8th edn) and WHO/ISUP grade I/II (Fuhrman grade I/II) are considered low-risk; RCC > 4-7 cm (stage T1b AJCC 8th edn) and WHO/ISUP grade I/II (Fuhrman grade I/II) are considered intermediate-risk; RCC > 7 cm (stage T2 AJCC 8th edn) and WHO/ISUP grade I/II (Fuhrman grade I/II) are considered high-risk; RCC with extension beyond the kidney (stages T3/T4 AJCC 8th edn) is considered a contraindication to transplant; All RCC with WHO/ISUP grade III/IV (Fuhrman grade III/IV) are considered high-risk for transmission; Contralateral kidneys and other organs that are un¬involved in carcinoma are considered to represent minimal risk for transplantation when the RCC in the involved kidney is 4 cm or less and WHO/ISUP grade I-II. In all cases, follow-up surveillance is desirable.
RCC in the donor history: The transmission risk of treated RCC depends on the histological type of tumour [159] and its recurrence-free follow-up period. In general, in the first 5 years after initial diagnosis, risk categories correspond to those stated above (RCC diagnosed during donor procurement) if there is no suspicion of tumour recurrence in the donor. After this time, the risk of advanced stages may decrease.
Time to detection:
13 years
Alerting signals, symptoms, evidence of occurrence:
None: masses detected on routine sonography followup (2.5 cm renal papillary carcinoma Fuhrman grade 1, and 1.5 cm angiomyolipoma)
Demonstration of imputability or root cause:
XY FISH analysis and microsatellite analysis both showed donor origin (male donor, female recipient)
Imputability grade:
3 Definite/Certain/Proven
Groups audience:
Keywords:
Suggest new keywords:
Case report
Deceased donor
Kidney transplant
FISH
XY chromosomes
Microsatellite analysis
DNA typing
Histologic analysis
Angiomyolipoma (benign)
Renal cell carcinoma
Reference attachment:
Suggest references:
Rotman S, Déruaz C, Venetz J-P, Chaubert P, Benhattar J, Meuwly J-Y, et al. De novo concurrent papillary renal cell carcinoma and angiomyolipoma in a kidney allograft: evidence of donor origin. Human pathology. 2006;37(4):481-7.
Note:
First review done 9/26 MN
Second review 10/08. MCS
Expert comments for publication:
Given the long time to development and the small size of the lesions, these are considered to represent de novo posttransplant neoplasms (one malignant, one benign) that arose in the donor kidney and were not "transmitted" as tumor masses at the time of transplantation. The authors note that ultrasounds performed in the first 7 posttransplant years did not show any lesions. An allograft nephrectomy was performed "for technical reasons" and the patient returned to dialysis. The authors note that there are only 50 reports of concurrent RCC and angiomyolipoma, and none reported in allograft kidneys. They also observed that none of the other recipients of organs from that donor developed tumor, although they do not specify what organs were transplanted. At the time of the report, the patient remained on dialysis without evidence of tumor for a period of 15 months.