Dramatic recurrence of cancer in a patient who underwent kidney transplantation--case report.
BACKGROUND
Besides cardiovascular diseases and infections, cancers are the main cause of death in patients after transplantation of a vascularized organ. After transplantation, usually de novo cancers develop. Recurrences of cancers that had been diagnosed and treated before transplantation are much rarer. In exceptional cases, cancer is transferred with the donor's organ. The epidemiology and the course of post-transplantation de novo neoplasia is relatively well known. However, the issue of recurrence of pre-transplantation cancer, which is significantly rarer and its course more individualized and difficult to predict, poses a challenge to contemporary transplantation.


METHODS
This paper presents an unexpectedly rapid recurrence of rare cancer-endometrial stromal sarcoma-that occurred shortly after transplantation of a kidney from a deceased donor to a patient who had undergone cancer treatment 7 years earlier. The dramatic course of the disease, complicated with recurrent massive thrombosis of the inferior vena cava and the right cardiac cavities, as well as pulmonary embolism and serious infectious complications, illustrates the difficulties related to qualifying patients with a history of malignancy for transplantation.


CONCLUSIONS
Based on this case report, we attempt to find an answer to the question about the risk of cancer recurrence in patients receiving immunosuppressive therapy and find out how it can be minimized. Answering these questions is particularly important if the recurrent cancer is substantially more aggressive, cancer treatment options are limited, and the prognosis is poor due to lack of immunocompetence.
Department of Transplantation Medicine and Nephrology, Transplantation Institute, Medical University of Warsaw, Warsaw, Poland. Electronic address: godlewska.r@wp.pl.
R
R
Wieczorek-Godlewska
Department of Transplantation Medicine and Nephrology, Transplantation Institute, Medical University of Warsaw, Warsaw, Poland.
D
D
Miszewska-Szyszkowska
Department of Transplantation Medicine and Nephrology, Transplantation Institute, Medical University of Warsaw, Warsaw, Poland.
K
K
Slubowska
Dialysis Center, Transplantation Institute, Medical University of Warsaw, Warsaw, Poland.
A
A
Ognista-Gajda
Department of General Surgery and Transplantology, Medical University of Warsaw, Warsaw, Poland.
A
A
Chmura
Department of Transplantation Medicine and Nephrology, Transplantation Institute, Medical University of Warsaw, Warsaw, Poland.
M
M
Durlik
D002908:Chronic Disease; D016889:Endometrial Neoplasms / Q000150:complications / Q000473:pathology*; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D016867:Immunocompromised Host; D007165:Immunosuppression Therapy; D016030:Kidney Transplantation; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000150:complications; D018579:Patient Selection; D011379:Prognosis; D018203:Sarcoma, Endometrial Stromal / Q000150:complications / Q000473:pathology*