Concurrent Presentation of High-Grade Lymphoma and Metastatic Pancreatic Neuroendocrine Tumor 14 Years After Renal Transplant

Abstract

The development of malignancy, especially lymphoma, is common after solid organ transplant. However, concurrent malignancies are rare and result in a diagnostic and treatment dilemma, particularly in the post-transplant setting. We present a case of a 78-year-old male who was discovered to have a high-grade post-transplant lymphoproliferative disorder (PTLD) and metastatic pancreatic neuroendocrine tumor (PNET) 14 years after kidney transplant. He presented with abdominal pain and at surgical resection was found to have a large small intestine tumor that was consistent with high-grade diffuse large B cell lymphoma. Immune suppression was reduced, and staging workup was completed. Positron emission tomography-computed tomography (PET-CT) showed fluorodeoxyglucose (FDG)-avid metastatic lesions in the liver and a mass in the pancreatic head. Before treatment was initiated, biopsy of a liver lesion revealed metastatic PNET. Due to aggressiveness and potential high mortality of the lymphoma, he was started on rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone (R-CHOP). After five cycles he developed worsening abdominal pain consistent with progression of the PNET and was placed on everolimus. Here we discuss the complexity of diagnosing concurrent primaries and the treatment of such in the post-transplant setting. J Hematol. 2014;3(4):112-115 doi: http://dx.doi.org/10.14740/jh180w