Kidney tumor - Post-kidney transplant tumors

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Kidney tumor

Other adult malignancies

Post-kidney transplant tumors

Reviewers: Sean Williamson, M.D., Mandolin Ziadie, M.D. (see Reviewers page)
Revised: 14 July 2012, last major update July 2012
Copyright: (c) 2003-2012, PathologyOutlines.com, Inc.

General
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● Malignancy occurring after renal transplant
● See also Lymphomas: non B cell chapter for discussion on post-transplant lymphoproliferative disorders
● Tumors can rarely be of donor origin (glioblastoma multiforme - Hum Pathol 1993;24:1256, lymphoma - Hum Pathol 1991;22:1291), but are usually due to immunosuppression
● 1.9x risk for cancers due to immunosuppression, ~ 5% of patients after 5 years (Ann Transplant 2011;16:14)

Most common post-kidney transplant malignancies
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● Italian study: viral related: Kaposi’s sarcoma and EBV+ non-Hodgkin’s lymphoma, with common sites being native kidney, uterus and liver (Epidemiol Prev 2008;32:205)
● Thailand study: urothelial and hepatocellular carcinomas (Transplant Proc 2008;40:2403)
● Korean study: stomach cancer, 10x risk of these tumors: Kaposi’s sarcoma, lymphoma, skin cancer, cervical, renal cell carcinoma (Transpl Int 2011;24:716)
● National Cancer Institute study (kidney plus other solid organ recipients): most common malignancies are non-Hodgkin lymphoma, lung (1.46 SIR in kidney recipients), kidney (6.66 SIR in kidney recipients, JAMA 2011;306:1891)

Hodgkin’s lymphoma:
● 2% of post-transplant lymphomas, occur mean 4 years after transplant; usually males
● Case report at Arch Pathol Lab Med 2001;125:1480
● Typical staining of Reed-Sternberg cells is CD30+, EBER+, CD15 variable, negative for B and T cell markers (Hum Pathol 1997;28:493), micro images

Non-Hodgkin lymphoma:
● Well-recognized risk post-transplant, usually EBV-associated extranodal B cell lymphomas that respond to reduction of immunosuppressive treatment
● EBV promotes proliferation of B cells, which may escape T cell control

Post-transplant lymphoproliferative disorders:
● Plasmacytic and polymorphic B cell hyperplasias are not monoclonal by flow cytometry
● Most B cell lymphomas or myelomas are clonal by flow cytometry, even if genotypic studies are negative (Am J Clin Pathol 2002;117:24)

Skin cancer:
● Increased risk of skin cancers (Br J Dermatol 2006;154:498)

Post kidney transplant tumors (not in kidney):
● Bladder urothelial carcinoma, polyoma virus+ (Br J Cancer 2008;99:1383)
● GIST of pelvic cavity (Clin Exp Nephrol 2011 Oct 19 [Epub ahead of print])
● Kaposi’s sarcoma in 5 year old boy (Hum Pathol 1992;23:956)
● Plasmacytoma in tonsil (Arch Pathol Lab Med 2004;128:e76)
● T cell lymphoma (Am J Surg Pathol 1993;17:1046)
● T cell lymphoma of vulva (Am J Surg Pathol 1993;17:842)

Treatment
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● Reduction in immunosuppression usually not sufficient for tumors in general, also need chemotherapy (Acta Haematol 2008;120:36)

Post-kidney transplant tumors, not in kidney
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● Bladder urothelial carcinoma, polyoma virus+ (Br J Cancer 2008;99:1383)
● Kaposi’s sarcoma (5 year old boy, Hum Pathol 1992;23:956)
● Plasmacytoma in tonsil (63 year old man, Arch Pathol Lab Med 2004;128:e76)
● T cell lymphoma, site unknown (Am J Surg Pathol 1993;17:1046)
● T cell lymphoma of vulva (Am J Surg Pathol 1993;17:842)

Micro images
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Post-transplant hemolytic-uremic syndrome

Diffuse large B-cell lymphoma

Membranous glomerulonephritis post kidney transplantation

Atypical lymphoid cells with posttransplant lymphoproliferative disease (PTLD)

End of Kidney tumor > Other adult malignancies > Post-kidney transplant tumors

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