Diffuse Micro-Nodules on Peritoneal Surfaces at Donor Organ Procurement: Highlights on the Diagnostic Challenge and Transplant Management

Abstract

Patient: Female, 41-year-old Final Diagnosis: Diffuse leiomyomatosis Symptoms: None Medication:— Clinical Procedure: — Specialty: Pathology Objective: Rare disease Background: Guidelines have been designed to stratify the risk of cancer transmission in donors with a history of or ongoing malignancy, although this evaluation is not always straightforward when unexpected and rare lesions are found. Case Report: Here, we present a case of a 41-year-old African female donor who died from a cerebral hemorrhage. Her medical history was unavailable. At procurement, multiple diffuse grayish small nodules were noticed along the peritoneal cavity, some of which were sent to the on-call pathologist for urgent frozen section evaluation. Histology showed a multinodular proliferation of uniform bland-appearing spindle cells, with no evidence of necrosis, nor nuclear atypia or mitoses. The overall picture was consistent with the diagnosis of disseminated peritoneal leiomyomatosis, with overlapping morphology with uterine leiomyoma. Given the rarity of the lesion and the potential for recurrence or malignant degeneration, only the liver and heart were allocated to recipients with life-threatening conditions. The decision was taken in a forcedly limited time and took into account the benefit of transplantation and the risk of disease transmission. Conclusions: This case highlights challenges that transplant teams often have to deal with, as lesions that are difficult to diagnose during donor assessment are usually not covered in guidelines. The acceptance and usage of organs in such cases has to be decided in a team-based fashion, with the collaboration of all the transplant professionals involved to optimally assess the transmission risk, carefully balancing the benefits of transplantation for the recipients and the need to guarantee a reasonable degree of safety.

Second Opinion in the Italian Organ Procurement Transplantation: The Pathologist Is In

“…The consultation requests are managed by a pathologist, who is a pivotal figure in the process and who defines the donor’s risk profile, helping centers to evaluate donors’ medical history and to plan clinical, radiological, or pathological investigations. The impact of correct risk assessment is paramount, considering the possible recovery of organs that would have been erroneously discarded or, conversely, the possibly correct discarding of donors with unacceptable risk profiles [ 24 , 25 , 26 ]. The consultations provided by the second opinion service led to a safer and more homogeneous management of donors by transplant centers.…”