Case report: Glioblastoma multiforme (2004)

Record number:

Adverse Occurrence type:

Astrocytoma/glioblastoma multiforme (WHO grade 4)

MPHO Type:

Estimated frequency:

- Most recent risk assessment for astrocytoma WHO grades 3 or 4 and glioblastoma WHO grade 4 (Council of Europe, 2025): Spontaneous extraneural metastases of grade 3 astrocytomas and grade 4 glioblastomas 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 WHO grade 3 astrocytomas can be accepted as organ donors. Transmission risk is considered low to intermediate for tumours without any risk factors. Potential donors with glioblastoma IDH-wildtype or astrocytoma IDH-mutant are considered intermediate risk for transmission, depending on different national recommendations, which are expected to be adjusted with increasing evidence. The transmission risk is increased in all cases with previous interventions such as tumour resection, ventriculo-peritoneal/-atrial drainage and/or cranial chemo-/radiotherapy.

Time to detection:

3 months (but donor hilar lymph node biopsied at time of transplant was interpreted as metastatic glioblastoma on final pathology report)

Alerting signals, symptoms, evidence of occurrence:

Three months after bilateral lung transplantation, patient found to have diffuse bilateral pulmonary infiltrates and pleural effusions. Diagnosis of metastatic Glioblastoma Multiforme (GBM) was made through bronchoscopy and transbronchial biopsy.

Demonstration of imputability or root cause:

Donor diagnosed was diagnosed with Glioblastoma multiforme (GBM) 1 year before death by stereotactic brain biopsy, but known to have a 9- by 7-cm parietal mass for 3 years. Donor was treated with steroids for 2 years and with radiotherapy. Lungs, heart, kidneys and liver were transplanted into five different recipients. One enlarged hiliar lymph node had been found while the lungs were being transplanted; the lymph node was removed and was consistent with metastatic GBM of the small cell type.GBM found in lung transplant recipient had identical histological features to those seen in the lymph node previously mentioned.More than one recipient from the same donor was affected: bilateral lung and liver recipients. One kidney recipient had transplantectomy, tumor not mentioned. Other kidney and heart recipients had no evidence of transmission.

Imputability grade:

3 Definite/Certain/Proven

Groups audience:

Malignancy

Keywords:

GBM (glioblastoma multiforme)