Bladder transitional cell carcinoma and BK virus in a young kidney transplant recipient

Abstract

Kidney transplant recipients have a heightened risk of developing neoplasms. Immunosuppressive treatments decrease the incidence of transplant rejection but increase the risk of infections, including BK virus (BKV). This infection is acquired in childhood and remains latent in the renal and urinary epithelium. In cases of immunodeficiency, BKV has been implicated as a tumor virus, but the role of BKV in cancer is a controversial topic and is difficult to determine. In the tumor cells, it is possible to detect fragments of the viral genome that could alter the control mechanisms of the cell cycle and DNA repair. We report the case of a kidney transplant recipient who developed BKV nephropathy and carcinoma of the bladder, supporting a possible role for BKV in the oncogenic pathway in this clinical setting, but the role of BKV in cancer remains a controversial topic and difficult to determine.

High-grade urothelial carcinoma in a kidney transplant recipient after JC virus nephropathy: The first evidence of JC virus as a potential oncovirus in bladder cancer

“…The potential association of BKV infection with urothelial malignancy has been postulated with limited conclusions due to the controversy over the pathobiology of viral cellular effects (lytic infection vs oncogenesis) . Because the association of BKV and bladder neoplasms is rare, the natural history, prognosis, and most suitable treatment of these tumors is uncertain …”

“…19 Because the association of BKV and bladder neoplasms is rare, the natural history, prognosis, and most suitable treatment of these tumors is uncertain. 20 Limited tools are available for investigating the potential association between JCV infection and carcinogenesis. These include cell morphology evaluation and immunohistochemical analysis for viral proteins and proliferation/oncogenesis-associated cell proteins.…”

Unusual BK polyomavirus‐associated urologic malignancies in renal transplant recipients: Report of two cases and review of the literature

“…However, the most serious complication of BKV in these patients is the development of urologic malignancies. Fortunately, such complications are rare and only 36 cases of urothelial carcinoma (UC) (Table ), and several renal cell carcinomas, including collecting duct carcinomas were reported to date …”

Urothelial cell carcinoma after BK polyomavirus infection in kidney transplant recipients: A cohort study of veterans

“…A plethora of case reports and case series since 2002 have described KTR with incident cases of UCC after BKPyV infection . However, the first population‐based study to examine the relationship between BKPyV and UCC in KTR was only recently published by Liu et al .…”

“…A plethora of case reports and case series since 2002 have described KTR with incident cases of UCC after BKPyV infection. 10,11,[18][19][20][21][22][23][24][25][26][27][28][29][30] However, the first population-based study to examine the relationship between BKPyV and UCC in KTR was only recently published by Liu et al 31 This study was designed as a retrospective single-center case-control analysis of KTR, and found the relative risk of developing UCC in BKPyV-positive cases was 11.6 (95% confidence interval [CI]: 2.2-211) compared to their BKPyV-negative matched controls. One potential critique of this otherwise well-designed study is that the presence of decoy cells on urine cytology was considered as sufficient criteria for inclusion as a BKPyV-positive case, rather than requiring more direct evidence of BKPyV infection such as the presence of BKPyV in urine or blood.…”