Transitional cell carcinoma involving graft kidney in a kidney transplant recipient: a case report

Yoon Kyung Chang,Hyeon Seok Hwang,Yu Ah Hong,Hae Joung Sul,Suk Young Kim

doi:10.1186/s12882-017-0715-2

Yoon Kyung Chang, Hyeon Seok Hwang + Show 3 more

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https://doi.org/10.1186/s12882-017-0715-2

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Journal: BMC Nephrology	Publication Date: Sep 21, 2017
Citations: 6	License type: open-access

Affiliation: Catholic University of Korea

Abstract

BackgroundKidney transplantation (KT) is the treatment option for patients with end stage renal disease (ESRD) to prolong survival and improve quality of life. Although the use of potent immunosuppressive agents increases graft survival in kidney transplantation recipients (KTRs), it may lead to the development of malignancy, including transitional cell carcinoma (TCC). TCC developing in the pelvis of graft kidney is very rare in KTRs.Case PresentationA 40-year-old male visited hospital with complaints of nausea, vomiting and gross hematuria. Eleven years ago, he was diagnosed ESRD of unknown origin, and received a living related KT from his father 1 year later. Radiologic findings showed a huge polypoid mass in the pelvis of graft kidney with pelvo-calyceal dilation and a 3.3 cm-sized nodule in aortocaval chain and a 2.5 cm-sized nodule in right iliac chain as TCC stage IV. Sonography-guided percutaneous needle biopsy of pelvis mass in the graft kidney revealed a low grade urothelial cell carcinoma. Radical graft nephroureterectomy was performed and histopathological diagnosis confirmed as a low grade urothelial carcinoma of graft pelvis and ureter lumen, which invaded to perirenal fat and renal parenchyma with lymphovascular presence (T3Nx). The patient started with adjuvant concurrent chemo-radiation therapy and returned to regular hemodialysis.ConclusionsWe report a rare case of TCC in the pelvis of graft kidney with already advanced disease at diagnosis in a young KTR. For the early diagnosis of TCC in KTRs, exposure history to Chinese herb or analgesics should be investigated before KT and high risk population in KTRs should be tightly performed regular postoperative surveillance for TCC and considered of less calcineurin inhibitor-based immunosuppressant protocol.

Highlights

Kidney transplantation (KT) is the treatment option for patients with end stage renal disease (ESRD) to prolong survival and improve quality of life
We report a rare case of transitional cell carcinoma (TCC) in the pelvis of graft kidney with already advanced disease at diagnosis in a young kidney transplantation recipients (KTRs)
For the early diagnosis of TCC in KTRs, exposure history to Chinese herb or analgesics should be investigated before KT and high risk population in KTRs should be tightly performed regular postoperative surveillance for TCC and considered of less calcineurin inhibitor-based immunosuppressant protocol

Summary

Conclusions

We report a rare case of TCC of graft kidney in a KTR with already advanced disease at diagnosis. In geographic neighboring location to China and Korean culture familiar to Chinese herb, the incidence of TCC in KTRs might be expected to increase. We did not elucidate causative risk factors of TCC in our patient, the investigation of exposure history to Chinese herb or analgesics is important to early detect TCC in KTRs. High risk population in KTRs should be tightly performed regular postoperative surveillance for TCC and considered of less calcineurin inhibitorbased immunosuppressant protocol. Abbreviation ESRD: End stage renal disease; KT: Kidney transplantation; KTR: Kidney transplant recipient; PET: Positron emission tomography; SUV: Standardized uptake value; TCC: Transitional cell carcinoma

Background

Discussion