An Unusual Course of Donor-Transmitted Angiosarcoma after Lung Transplantation

Abstract

Introduction Donor-transmitted vascular tumors are a rare complication after lung transplantation. Case Report A 35-year-old woman underwent bilateral lung transplantation for primary ciliary dyskinesia. Three years post-transplant, a nodule in the right upper lung lobe was detected on routine computer tomography. Wedge resection showed a hemangioma. One year later, two new lung nodules, as well as two liver lesions appeared, and vascular lesions without signs of malignancy were diagnosed on laparoscopic liver biopsies. After switching from tacrolimus to sirolimus, the volume of the lesions significantly decreased. However, two years later, mixed solid tissue lesions developed in both ovaries, while the lung and liver lesions gradually increased in volume again. Histological examination after bilateral salpingectomy was compatible with bilateral angiosarcoma. Tumor analysis by haplotyping and human leukocyte antigen typing showed mixed donor-chimerism, proving that the tumoral lesions in the lungs and ovaries were of donor origin. In retrospect, the donor became brain death following brain surgery complications for a previously biopsy-proven cerebral hemangioma, which is believed to have been a precursor lesion of this vascular malignancy. Summary Our case highlights a unique course of donor-related angiosarcoma, finally diagnosed 6 years after lung transplantation. Donor-origin of tumors detected in solid organ recipients should always be suspected in case of uncommon disease course or histology, and proper tissue-based diagnosis using sensitive techniques should be pursued, given the possible implications for treatment and outcome of other organ recipients in case of multi-organ donation.