University Hospitals Case Medical Center Cleveland, OH, United States
Adrian Lindsey, MD1, Kyle Hoffman, MD1, Perica Davitkov, MD2, Anamay N. Sharma, MD2 1University Hospitals Case Medical Center, Cleveland, OH; 2Louis Stokes Cleveland VA Medical Center, Cleveland, OH
Introduction: Donor-derived malignancy after transplant is rare with one kidney transplant center reporting undetected malignancy rates of 0.2% and transmission rates of 1.3%.1 We present a case of donor-derived small cell carcinoma of the liver after liver transplantation.
Case Description/Methods: A 67-year-old man with a history of chronic hepatitis C complicated by liver cirrhosis and hepatocellular carcinoma was treated with an orthotopic liver transplantation (OLT) 11 months prior to presentation. Surveillance MRI of the liver 10 months post-transplant showed interval development of multiple masses in both lobes of the liver with the largest being 3.6 x 2.7 centimeter. A liver biopsy was then performed which showed tumor compromise of cells with scant cytoplasm, small blue oval nuclei, and an overall pathologic evaluation consistent with small cell carcinoma involving the allograft liver. PET did not show any FDG-avid lung nodules, though avidity of the disseminated liver lesions and periportal, aortocaval, and retrocrural metabolic adenopathy was noted. FISH testing was performed on tumor cells revealing two X chromosomes consistent with a donor-derived tumor. Patient was not a surgical candidate and was initiated on etoposide and cisplatin.
Discussion: Risk for several types of malignancy increases after transplantation, likely related to immunosuppression. The risk of donor-derived malignancy after transplant is increasing in light of the aging donor pool.2 Small cell carcinoma of the liver has been previously described after OLT in one case report by Foltys, et al.2 Even in the absence of a lung focus, given that primary small cell carcinoma of the liver is rare, the lung is hypothesized to be the primary site. Given the aggressive nature of small cell carcinoma and an increasing risk of donor-derived cancer, providers should have an understanding of this pathology and remain vigilant in the liver transplant population.
Birkeland SA, et al. Risk for tumor and other disease transmission by transplantation: a population-based study of unrecognized malignancies and other diseases in organ donors. Transplantation. 2002;74(10):1409.
Foltys D, et al. Organ recipients suffering from undifferentiated neuroendocrine small-cell carcinoma of donor origin: a case report. Transplant Proc. 2009;41(6) : 2639-42.
Disclosures: Adrian Lindsey indicated no relevant financial relationships. Kyle Hoffman indicated no relevant financial relationships. Perica Davitkov indicated no relevant financial relationships. Anamay Sharma indicated no relevant financial relationships.
Adrian Lindsey, MD1, Kyle Hoffman, MD1, Perica Davitkov, MD2, Anamay N. Sharma, MD2. P0750 - A Case of Donor-Derived Small Cell Carcinoma of the Liver in a Liver Transplant Patient, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.