title: Donor kidneys with miliary papillary renal cell neoplasia: the role of the pathologist in determining suitability for transplantation.
abstract: BACKGROUND
  Kidneys with single or multiple tumors, provided that they have histological features recognized as being associated with low risk of recurrence, are considered suitable for transplantation. It is known that kidneys with multiple primary renal tumors show poor renal function and that function dramatically declines when tumors have a miliary configuration. Despite this, no guidelines are in place to differentiate between multifocal tumors and those that are miliary in nature.
  
  
  METHODS
  We report a case in which initial examination revealed papillary renal cell neoplasia in deceased donor kidneys, which were later confirmed on histological and genetic testing to be multiple and miliary in distribution. Gross examination showed closely opposed neoplasms, and on histological examination these were found to be papillary renal cell carcinomas and renal papillary adenomas. This ultimately led to the decision that both kidneys were unsuitable for transplantation.
  
  
  CONCLUSIONS
  At present there are no recommendations as to how tumor-bearing donor kidneys should be handled in order to determine if miliary neoplasia is present. From our case it is apparent that, in addition to obvious tumor nodules, at least 3 samples of cortex should be examined. This case highlights the important role of the pathologist in assessing donor kidneys with evidence of neoplasia.
authors: DAI Pathology and Diagnostics, Azienda Ospedaliera Universitaria Integrata (AOUI) University Hospital, Verona, Italy.
authors: Albino
authors: A
authors: Eccher
authors: Kidney Transplant Center, Surgery Unit, Azienda Ospedaliera Universitaria Integrata (AOUI) University Hospital, Verona, Italy.
authors: Luigino
authors: L
authors: Boschiero
authors: Kidney Transplant Center, Surgery Unit, Azienda Ospedaliera Universitaria Integrata (AOUI) University Hospital, Verona, Italy.
authors: Francesca
authors: F
authors: Fior
authors: Neurosurgery and Intensive Care Unit, Azienda Ospedaliera Universitaria Integrata (AOUI) University Hospital, Verona, Italy.
authors: Marilena
authors: M
authors: Casartelli Liviero
authors: Neurosurgery and Intensive Care Unit, Azienda Ospedaliera Universitaria Integrata (AOUI) University Hospital, Verona, Italy.
authors: Laura
authors: L
authors: Zampicini
authors: DAI Pathology and Diagnostics, Azienda Ospedaliera Universitaria Integrata (AOUI) University Hospital, Verona, Italy.
authors: Claudio
authors: C
authors: Ghimenton
authors: Department of Pathology, University of Bologna, Bologna, Italy.
authors: Antonietta
authors: A
authors: D'Errico-Grigioni
authors: Department of Pathology and Diagnostics, University of Verona, Verona, Italy.
authors: Anna
authors: A
authors: Caliò
authors: Department of Pathology and Diagnostics, University of Verona, Verona, Italy.
authors: Guido
authors: G
authors: Martignoni
authors: Department of Pathology and Molecular Medicine, Wellington School of Medicine and Health Sciences, University of Otago, Wellington, New Zealand.
authors: Brett
authors: B
authors: Delahunt
authors: Department of Pathology and Diagnostics, University of Verona, Verona, Italy.
authors: Matteo
authors: M
authors: Brunelli
mesh_terms: D000236:Adenoma / Q000235:genetics / Q000473:pathology*; D002102:Cadaver; D002292:Carcinoma, Renal Cell / Q000235:genetics / Q000473:pathology*; D004273:DNA, Neoplasm / Q000032:analysis; D006801:Humans; D007668:Kidney / Q000473:pathology*; D007680:Kidney Neoplasms / Q000235:genetics / Q000473:pathology*; D016030:Kidney Transplantation / Q000592:standards*; D008297:Male; D008875:Middle Aged; D014019:Tissue Donors; D009927:Tissue and Organ Procurement / Q000592:standards*
chemical_list: D004273:DNA, Neoplasm