title: De Novo Renal Neoplasia After Kidney Transplantation According to New 2016 WHO Classification of Renal Tumors.
abstract: BACKGROUND De novo renal neoplasia developing after kidney transplantation at Verona Kidney Transplant Center were reviewed according to new 2016 WHO Renal Tumor Classification. MATERIAL AND METHODS Primary renal tumors developed in native or transplanted kidneys de novo following renal transplantation were retrieved and histologically reviewed by three expert uropathologists. Immunoexpression of the diagnostic antigens CD13, CD10, CK7, CK34bE12, AMACR, CAIX, AE1/AE3, CK14, GATA-3, HMB-45, cathepsin-k, S100A1, and parvalbumin was assessed. Predictive antigens ph-mTOR and ph-p70S6k were also tested. RESULTS Two thousands and sixteen kidney transplantations have been carried out from 1968-2015. Follow-up was available per 1,646 patients (mean 8.4 years). We observed 16 cases of de novo renal neoplasia arising in patients 16 to 286 months post-transplantation. Nine clear cell, two papillary RCCs and a single case of the new WHO entity denominated "acquired cystic disease-associated RCC" were identified in native kidneys. Another new WHO tumor entity called "clear cell papillary RCC" was diagnosed and a new variant of papillary RCC with diffuse clear cytoplasm was also identified. The majority of tumors were low stage and low grade according to the new ISUP grading system. Seven patients were additionally treated with mTOR inhibitors. Post-cancer follow-up ranged from 62 to 281 months. One patient showed a recurrence (a lung metastases) and died. Of the remaining patients, three died of non-cancer-related causes. CONCLUSIONS The application of the new WHO 2016 classification has importance as it identifies new (18% of tumors) morphotypes that are likely to behave in a less aggressive fashion.
authors.affiliation: Department of Diagnostics and Public Health, University and Hospital Trust of Verona, Verona, Italy.
authors.forename: Albino
authors.initials: A
authors.lastname: Eccher
authors.affiliation: Department of Surgical Science, Kidney Transplant Center, University and Hospital Trust of Verona, Verona, Italy.
authors.forename: Luigino
authors.initials: L
authors.lastname: Boschiero
authors.affiliation: Department of Pathology and Molecular Medicine, Wellington School of Medicine and Health Sciences, Wellington, New Zealand.
authors.forename: Brett
authors.initials: B
authors.lastname: Delahunt
authors.affiliation: Department of Diagnostics and Public Health, University and Hospital Trust of Verona, Verona, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Cima
authors.affiliation: Department of Surgical Science, Kidney Transplant Center, University and Hospital Trust of Verona, Verona, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Fior
authors.affiliation: Department of Surgical Science, Kidney Transplant Center, University and Hospital Trust of Verona, Verona, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Nacchia
authors.affiliation: Department of Surgical Science, Kidney Transplant Center, University and Hospital Trust of Verona, Verona, Italy.
authors.forename: Momo
authors.initials: M
authors.lastname: Rostand
authors.affiliation: Department of General Surgery and Odontoiatrics, Liver Transplant Unit, University and Hospital Trust of Verona, Verona, Italy.
authors.forename: Amedeo
authors.initials: A
authors.lastname: Carraro
authors.affiliation: Department of General Surgery and Odontoiatrics, Liver Transplant Unit, University and Hospital Trust of Verona, Verona, Italy.
authors.forename: Umberto
authors.initials: U
authors.lastname: Tedeschi
authors.affiliation: Department of Medicine, Renal Unit, University and Hospital Trust of Verona, Verona, Italy.
authors.forename: Gianluigi
authors.initials: G
authors.lastname: Zaza
authors.affiliation: Department of Surgical Science, Neurosurgery and Intensive Care Unit, University and Hospital Trust of Verona, Verona, Italy.
authors.forename: Marilena
authors.initials: M
authors.lastname: Casartelli Liviero
authors.affiliation: Department of Surgical Science, Neurosurgery and Intensive Care Unit, University and Hospital Trust of Verona, Verona, Italy.
authors.forename: Laura
authors.initials: L
authors.lastname: Zampicinini
authors.affiliation: Department of Diagnostics and Public Health, University and Hospital Trust of Verona, Verona, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Chilosi
authors.affiliation: Transplant Regional Center, Veneto Region, Hospital Trust of Padova, Padova, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Feltrin
authors.affiliation: Transplant Regional Center, Veneto Region, Hospital Trust of Padova, Padova, Italy.
authors.forename: Claudio
authors.initials: C
authors.lastname: Rago
authors.affiliation: Department of Specialised, Experimental and Diagnostic Medicine, Sant'Orsola-Malpighi University Hospital of Bologna, Bologna, Italy.
authors.forename: Antonietta
authors.initials: A
authors.lastname: D'Errico
authors.affiliation: Department of Diagnostics and Public Health, University and Hospital Trust of Verona, Verona, Italy.
authors.forename: Claudio
authors.initials: C
authors.lastname: Ghimenton
authors.affiliation: Department of Diagnostics and Public Health, University and Hospital Trust of Verona, Verona, Italy.|Anatomic Pathology, Pederzoli Hospital, Peschiera Del Garda, Italy.
authors.forename: Guido
authors.initials: G
authors.lastname: Martignoni
authors.affiliation: Department of Diagnostics and Public Health, University and Hospital Trust of Verona, Verona, Italy.|FISH Lab, Azienda Ospedaliera Universitaria Integrata (AOUI), University and Hospital Trust of Verona, Verona, Italy.
authors.forename: Matteo
authors.initials: M
authors.lastname: Brunelli
mesh_terms: D000328:Adult; D000368:Aged; D014408:Biomarkers, Tumor / Q000378:metabolism; D002292:Carcinoma, Renal Cell / Q000209:etiology* / Q000378:metabolism / Q000473:pathology; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000209:etiology* / Q000378:metabolism / Q000473:pathology; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011183:Postoperative Complications / Q000473:pathology; D012189:Retrospective Studies
chemical_list: D014408:Biomarkers, Tumor