Abstract
Although a well-known complication after transplantation, multiple non-skin malignancies within a patient are rare. We report on a kidney transplant recipient who over the course of 20 years developed breast cancer twice, a uroepithelial carcinoma, and myelodysplasia transforming into acute leukaemia. Breast cancer was treated as usual. The transitional cell carcinoma was managed with partial cyst ureterectomy with transposition of the native ureter to the graft. Withdrawal of immunosuppression followed under a “watchful waiting” regime. In conclusion, alertness is requested regarding development of malignancies. Creative solutions are necessary in the management of such patients. Under exceptional circumstances, withdrawal of immunosuppression may be an option.
Highlights
The occurrence of malignancy after organ transplantation is well known
The appearance of certain entities varies widely, with lip and skin cancer yielding the highest standardized incidence rates (SIR) and others, including breast cancer, with even lower SIR among transplant recipients compared with the general population [2]
We report on a patient with an >20-year lasting course after kidney transplantation who experienced two distinct breast cancers and a transitional cell carcinoma of the urinary tract and, despite withdrawing immunosuppression, developed myelodysplastic syndrome 19 months later transforming into acute terminal leukaemia
Summary
The occurrence of malignancy after organ transplantation is well known. Large registries show a 3- to 5-fold increased risk compared with age-matched controls [1]. We report on a patient with an >20-year lasting course after kidney transplantation who experienced two distinct breast cancers and a transitional cell carcinoma of the urinary tract and, despite withdrawing immunosuppression, developed myelodysplastic syndrome 19 months later transforming into acute terminal leukaemia. Case report In February 1992, a 48-year-old woman with end-stage renal disease from analgesic nephropathy successfully underwent kidney transplantation.
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