Bladder carcinoma in a transplant recipient: evidence to implicate the BK human polyomavirus as a causal transforming agent.
The BK polyomavirus (BKV) infects most of the human population, but clinically relevant infections are mostly limited to individuals who are immunosuppressed. In transplant recipients, BKV has been associated with ureteral stenosis, interstitial nephritis, and hemorrhagic cystitis. The role of BKV in the development of human tumors is intriguing but uncertain. BKV has been identified in various tumor types including urothelial carcinoma, but the ubiquitous presence of BKV as a latent infection has confounded efforts to validate any causal role in cancer development. We report the case of a simultaneous pancreas and kidney transplant recipient who developed BKV interstitial nephritis and carcinoma of the bladder with widespread metastases. High level expression of BKV large T antigen in the primary and metastatic carcinoma, but not in the nonneoplastic urothelium, implicates BKV as an etiologic agent in the development of this tumor.
Department of Medicine, The Johns Hopkins Hospital Medical Institutions, Baltimore, Maryland 21231, USA.
Duvuru
D
Geetha
Betty C
BC
Tong
Lorraine
L
Racusen
Jay S
JS
Markowitz
William H
WH
Westra
D001739:BK Virus; D004279:DNA, Viral / Q000032:analysis; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D016035:Pancreas Transplantation / Q000009:adverse effects*; D027601:Polyomavirus Infections / Q000150:complications*; D014412:Tumor Virus Infections / Q000150:complications*; D001749:Urinary Bladder Neoplasms / Q000209:etiology* / Q000473:pathology
D004279:DNA, Viral