title: A liver nodule in a patient transplanted for primary sclerosing cholangitis: an interdisciplinary diagnostic approach.
abstract: We report the case of a 53-year-old female patient who was transplanted with the liver of a 71-year-old male donor for advanced primary sclerosing cholangitis (PSC) and who additionally was diagnosed with a histologically non-classifiable colitis shortly before transplantation. Upon follow-up abdominal ultrasound 4 months after transplantation, a liver lesion measuring 16 × 23 mm was detected in the transplanted liver. This lesion had not been noticed immediately after transplantation and showed a pattern suspicious for malignancy in contrast-enhanced ultrasound. In line, a biopsy revealed the presence of a metastasis of an adenocarcinoma of colorectal origin, suggesting that a colitis- and PSC-associated colorectal cancer of the recipient might have been overseen upon the initial diagnostic workup. Despite two negative follow-up colonoscopies, this hypothesis was further supported by a strong positive signal in projection to the cecum in a subsequently performed PET/CT-scan. However, surgical resection of the right colon that was performed simultaneously with the atypical resection of the liver metastasis only revealed an inflamed diverticulum but no malignancy in the resected colon segment. Moreover, cytogenetic and molecular genetic testing on the resected specimens clearly attributed the metastasis to the male donor. On the one hand, this case underlines the necessity of endoscopic surveillance of patients with PSC and/or inflammatory bowel disease as well as the challenges in diagnosis of colitis-associated cancer. On the other hand, it shows that the acceptance of organs from elderly donors in times of organ shortage might be linked to an increased risk of donor transmitted malignancies.
authors.affiliation: Department of Gastroenterology, Digestive Diseases and Intensive Care Medicine (Department of Medicine III), University Hospital RWTH Aachen, Aachen, Germany.
authors.forename: Sven Heiko
authors.initials: SH
authors.lastname: Loosen
authors.affiliation: Department of General, Visceral and Transplantation Surgery, University Hospital RWTH Aachen, Aachen, Germany.
authors.forename: Maximilian
authors.initials: M
authors.lastname: Schmeding
authors.affiliation: Department of Gastroenterology, Digestive Diseases and Intensive Care Medicine (Department of Medicine III), University Hospital RWTH Aachen, Aachen, Germany.
authors.forename: Christoph
authors.initials: C
authors.lastname: Roderburg
authors.affiliation: Department of General, Visceral and Transplantation Surgery, University Hospital RWTH Aachen, Aachen, Germany.
authors.forename: Marcel
authors.initials: M
authors.lastname: Binnebösel
authors.affiliation: Department of Gastroenterology, Digestive Diseases and Intensive Care Medicine (Department of Medicine III), University Hospital RWTH Aachen, Aachen, Germany.
authors.forename: Ilknur
authors.initials: I
authors.lastname: Temizel
authors.affiliation: Department of Nuclear Medicine, University Hospital RWTH Aachen, Aachen, Germany.
authors.forename: Felix M
authors.initials: FM
authors.lastname: Mottaghy
authors.affiliation: Department of Gastroenterology, Digestive Diseases and Intensive Care Medicine (Department of Medicine III), University Hospital RWTH Aachen, Aachen, Germany.
authors.forename: Jens J W
authors.initials: JJ
authors.lastname: Tischendorf
authors.affiliation: Department of Gastroenterology, Digestive Diseases and Intensive Care Medicine (Department of Medicine III), University Hospital RWTH Aachen, Aachen, Germany.
authors.forename: Frank
authors.initials: F
authors.lastname: Tacke
authors.affiliation: Institute of Pathology, University Hospital RWTH Aachen, Aachen, Germany.
authors.forename: Nadine T
authors.initials: NT
authors.lastname: Gaisa
authors.affiliation: Institute of Pathology, Hannover Medical School, Hannover, Germany.
authors.forename: Kais
authors.initials: K
authors.lastname: Hussein
authors.affiliation: Institute of Pathology, Hannover Medical School, Hannover, Germany.
authors.forename: Ulrich
authors.initials: U
authors.lastname: Lehmann
authors.forename: Christian
authors.initials: C
authors.lastname: Trautwein
authors.affiliation: Department of General, Visceral and Transplantation Surgery, University Hospital RWTH Aachen, Aachen, Germany.
authors.forename: Ulf Peter
authors.initials: UP
authors.lastname: Neumann
authors.affiliation: Department of Gastroenterology, Digestive Diseases and Intensive Care Medicine (Department of Medicine III), University Hospital RWTH Aachen, Aachen, Germany.
authors.forename: Tom
authors.initials: T
authors.lastname: Luedde
mesh_terms: D000230:Adenocarcinoma / Q000175:diagnosis* / Q000209:etiology / Q000556:secondary*; D000368:Aged; D003937:Diagnosis, Differential; D046148:Donor Selection / Q000379:methods; D005260:Female; D005858:Germany; D006801:Humans; D008113:Liver Neoplasms / Q000175:diagnosis* / Q000209:etiology / Q000556:secondary*; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D010348:Patient Care Team / Q000458:organization & administration*; D014019:Tissue Donors