Primary Bronchogenic Carcinoma After Heart or Lung Transplantation: Radiologic and Clinical Findings

Abstract

Chronic immunosuppression in organ transplant recipients predisposes to the development of malignant disease. The authors describe their 29-year institutional experience of bronchogenic carcinoma developing after heart and lung transplantation. Seven cases of bronchogenic carcinoma were diagnosed in 1,119 heart and lung transplant recipients. Computed tomography scans and radiographs at time of diagnosis, as well as prior radiographs available in six patients were retrospectively analyzed by two radiologists in consensus. The seven cases involved six heart and one lung transplant recipients. Six patients were smokers with a mean smoking history of 66 pack-years. Mean time interval from transplantation to cancer detection was 25 months. Radiologic findings consisted of a solitary pulmonary nodule (n = 3), mass with satellite nodules (n = 1), and obstructive pneumonitis (n = 1). In the sixth patient, the cancer was not radiographically visible because of obscuration by adjacent fibrosis. On review, radiographic abnormalities were present a mean of 12 months prior to diagnosis in 66% of patients. In the heart or lung transplant population, bronchogenic carcinoma develops in recipients with extensive smoking histories. It presents radiographically as a nodule, mass, or obstructive pneumonitis, and is usually visible on radiographs before the time of diagnosis.

Long-term results of lung cancer after heart transplantation: Single center 20-year experience

“…Choi et al [24] identified pre-existing abnormalities by chest radiography around 12 months before eventual diagnosis in 66% of their patients.…”

Bronchial carcinoma after lung transplantation: A single-center experience

“…For kidney and heart transplant recipients, the prevalence of bronchogenic carcinoma has been found to range from 0.5% (kidney) to 2.8% (heart). [2][3][4] Now that lung transplantations throughout the world have been performed successfully for more than two decades, it has become possible to estimate the prevalence of lung cancer in lung transplant recipients.…”

Lung cancer in lung transplant recipients: Experience of a tertiary hospital and literature review

“…We noted a wide variation in prevalence between more recent [7,12] and earlier reports [13,14]. The higher rates in the later studies were probably a consequence of the inclusion of older recipients, given the increasing age of patients undergoing transplantation, and the increase in the intensity of the immunosuppression regimen over time (a risk factor both by itself and as a contributor to patient longevity).…”

“…Years Location Cancer cases/total transplants Pathology Spiekerkoetter [13] 1987-1997 Germany 1/219 (0.46%) SCC Choi et al [14] 1968-1997 USA (CA) 1/99 (1.1%) SCC Arcasoy et al [12] 1991 efforts are recommended because aggressive management may be beneficial in patients with earlier stage disease.…”