title: Malignancies confined to disused arteriovenous fistulae in renal transplant patients: an important differential diagnosis.
abstract: BACKGROUND
  Swelling in an arteriovenous fistula (AVF) is commonly caused by thrombosis, aneurysm and infection. However, due to the increased risk of malignancy after transplantation, this should also be considered.
  
  
  METHODS
  We discuss 4 patients with malignancy confined to an AVF after renal transplantation presenting in a 2-year period. Angiosarcoma was diagnosed in 3 patients and the other had post-transplant lymphoproliferative disorder (PTLD). Angiosarcoma behaves aggressively and 2 of our patients died within 6 months of diagnosis. There are 6 previous cases and 5 died within 16 months of diagnosis. PTLD at AVFs has not been documented previously.
  
  
  CONCLUSIONS
  Malignancy at an AVF is a rare but important differential that can impact significantly on patient morbidity and mortality. Predilection for malignancy at an AVF is not understood. We review the literature and discuss possible aetiologies.
authors.affiliation: Imperial College Healthcare NHS Trust, London, UK. p.webster@imperial.ac.uk
authors.forename: Philip
authors.initials: P
authors.lastname: Webster
authors.forename: Lareina
authors.initials: L
authors.lastname: Wujanto
authors.forename: Cyril
authors.initials: C
authors.lastname: Fisher
authors.forename: Marjorie
authors.initials: M
authors.lastname: Walker
authors.forename: Rathi
authors.initials: R
authors.lastname: Ramakrishnan
authors.forename: Kikkeri
authors.initials: K
authors.lastname: Naresh
authors.forename: J Meirion
authors.initials: JM
authors.lastname: Thomas
authors.forename: Vassilios
authors.initials: V
authors.lastname: Papalois
authors.forename: Jeremy
authors.initials: J
authors.lastname: Crane
authors.forename: David
authors.initials: D
authors.lastname: Taube
authors.forename: Neill
authors.initials: N
authors.lastname: Duncan
mesh_terms: D000328:Adult; D001166:Arteriovenous Shunt, Surgical; D003937:Diagnosis, Differential; D020031:Epstein-Barr Virus Infections / Q000150:complications; D005260:Female; D006394:Hemangiosarcoma / Q000175:diagnosis* / Q000209:etiology / Q000473:pathology / Q000628:therapy; D004854:Herpesvirus 4, Human; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D016030:Kidney Transplantation / Q000009:adverse effects*; D008232:Lymphoproliferative Disorders / Q000175:diagnosis* / Q000473:pathology / Q000628:therapy / Q000821:virology; D008297:Male; D008875:Middle Aged; D012878:Skin Neoplasms / Q000175:diagnosis* / Q000209:etiology / Q000473:pathology / Q000628:therapy
chemical_list: D007166:Immunosuppressive Agents