Bronchogenic carcinoma complicating lung transplantation.
BACKGROUND
Malignancy is a well-recognized complication of solid-organ transplantation. Although a variety of malignancies have been reported in lung transplant recipients, a paucity of information exists regarding the incidence and clinical course of bronchogenic carcinoma in this patient population.


METHODS
We conducted a retrospective cohort study of our lung transplant experience at the University of Pennsylvania.


RESULTS
We identified 6 patients with bronchogenic carcinoma detected at the time of, or developing after, transplantation. The incidence of bronchogenic carcinoma was 2.4%. All patients with lung cancer had a history of smoking, with an average of 79 +/- 39 pack-years. A total of 5 patients had chronic obstructive pulmonary disease, and 1 had idiopathic pulmonary fibrosis. Lung cancers were all of non-small-cell histology and first developed in native lungs. Three patients had bronchogenic carcinoma at the time of surgery. The remaining 3 patients were diagnosed between 280 and 1,982 days post-transplantation. Of the 6 patients, 4 presented with a rapid course suggestive of an infectious process. The 1- and 2-year survival rates after diagnosis were 33% and 17%, respectively.


CONCLUSIONS
Lung transplant recipients are at risk for harboring or developing bronchogenic carcinoma in their native lungs. Rapid progression to locally advanced or metastatic disease commonly occurs, at times mimicking an infection. Bronchogenic carcinoma should be considered in the differential diagnosis of pleuroparenchymal processes involving the native lung.
Arcasoy
S M
SM
Division of the Pulmonary, Allergy and Critical Care Medicine, University of Pennsylvania Medical Center, Philadelphia, Pennsylvania 19104-4283, USA. arcasoy@mail.med.upenn.edu
Hersh
C
C
Christie
J D
JD
Zisman
D
D
Pochettino
A
A
Rosengard
B R
BR
Blumenthal
N P
NP
Palevsky
H I
HI
Bavaria
J E
JE
Kotloff
R M
RM
D002283:Carcinoma, Bronchogenic / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D002289:Carcinoma, Non-Small-Cell Lung / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D015994:Incidence; D008175:Lung Neoplasms / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D016040:Lung Transplantation; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D012189:Retrospective Studies; D012907:Smoking / Q000009:adverse effects*; D016019:Survival Analysis
D007166:Immunosuppressive Agents