Recurrence of bronchioloalveolar carcinoma in donor lung after lung transplantation: Microsatellite analysis demonstrates a recipient origin

Abstract

Bronchioloalveolar carcinoma is a distinctive subtype of pulmonary adenocarcinoma, without effective therapy, although there have recently been some attempts to use lung transplantation. However, a high post-transplantation local recurrence rate is described with some controversy regarding the possible involved mechanisms, the main possibilities being the lymphatic spread and aerosolization. Presented herein is a case of a bilateral lung transplantation for a bilateral and pneumonic form of non-mucinous bronchioloalveolar carcinoma in a 43-year-old woman. The histological analysis of mediastinal lymph nodes during surgery did not show neoplastic cells. Thirty-five months after transplantation several nodular opacities in donor lungs were detected. Three pulmonary wedge resections were performed showing a non-mucinous bronchioloalveolar carcinoma with the same histological characteristics as the primary. Again, the mediastinal lymph nodes were tumor free. A complete microsatellites molecular analysis was performed to compare the primary and recurrent carcinoma using capillary electrophoresis, showing that the recurrent tumor was generated in a recipient cellular clone. The absence of lymph node metastasis and the molecular evidence of the recipient origin of the neoplasm supports the contamination of the new lungs at the time of implantation as being the reason for the high incidence of recurrence after lung transplantation in this kind of disease.

The IASLC Lung Cancer Staging Project: Background Data and Proposals for the Application of TNM Staging Rules to Lung Cancer Presenting as Multiple Nodules with Ground Glass or Lepidic Features or a Pneumonic Type of Involvement in the Forthcoming Eighth Edition of the TNM Classification

“…61,84,85 The observation that recurrence (which occurred in over half) was almost always confined to the (transplanted) lung [84][85][86][87] is both further evidence of the M A N U S C R I P T…”

Jaagsiekte Sheep Retrovirus (JSRV): from virus to lung cancer in sheep

“…Microsatellite analysis of the lung specimens of the donor and the recipient have showed that recurrent tumours originated from the transplant recipient [30,65]. Since BAC is considered as a localised disease (and excluding possible tumoural contamination during the transplantation procedure), these observations suggest the existence of either extra-pulmonary tumoural stem cells that would remain dormant for several years [32], or of infectious agents with an extrapulmonary preclinical reservoir.…”

Pulmonary Langerhans cell histiocytosis “de novo” after lung transplantation

“…We have also performed a molecular analysis based in 15 tetranucleotide repeat loci that demonstrated the LCs had a molecular profile similar to the receptor, and in consequence their origin was outside the implanted donor lungs. This kind of method has been used in other reports to demonstrate the origin of cells in transplant biopsies . This profile discards the possibility that the donor implanted lungs had a PLCH undetected.…”