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Schroder PM, Biesterveld BE, Al-Adra DP. Premalignant Lesions in the Kidney Transplant Candidate. Semin Nephrol 2024; 44:151495. [PMID: 38490902 DOI: 10.1016/j.semnephrol.2024.151495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2024]
Abstract
End-stage kidney disease patients who are referred for transplant undergo an extensive evaluation process to ensure their health prior to transplant due in part to the shortage of available organs. Although management and surveillance guidelines exist for malignancies identified in the transplant and waitlist populations, less is written about the management of premalignant lesions in this population. This review covers the less common premalignant lesions (intraductal papillary mucinous neoplasm, gastrointestinal stromal tumor, thymoma, and pancreatic neuroendocrine tumor) that can be found in the transplant candidate population. High-level evidence for the management of these rarer premalignant lesions in the transplant population is lacking, and this review extrapolates evidence from the general population and should not be a substitute for a multidisciplinary discussion with medical and surgical oncologists.
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Affiliation(s)
- Paul M Schroder
- Department of Surgery, Division of Transplantation, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Ben E Biesterveld
- Department of Surgery, Division of Transplantation, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - David P Al-Adra
- Department of Surgery, Division of Transplantation, University of Wisconsin School of Medicine and Public Health, Madison, WI.
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2
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Stammler R, Anglicheau D, Landi B, Meatchi T, Ragot E, Thervet E, Lazareth H. Gastrointestinal tumors in transplantation: Two case reports and review of literature. World J Gastroenterol 2022; 28:5076-5085. [PMID: 36160649 PMCID: PMC9494929 DOI: 10.3748/wjg.v28.i34.5076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 04/19/2022] [Accepted: 08/05/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the gastrointestinal tract. As most of them harbor a KIT mutation (75%), selective kinase inhibitors are the therapeutic option and show a sustained objective response among patients with metastatic or unresectable GISTs. A well-known higher risk of neoplasm has been described among renal transplant recipients (RTRs). Nevertheless, only few cases of GIST onset among transplant patients have been reported in the literature.
CASE SUMMARY Here, we describe 2 cases of gastric GIST occurring during the follow-up of RTRs. We also review the existing literature concerning GIST occurrence in transplant patients. In total and in association with our 2 cases, 16 patients have been reported. The median age was 59.5 years and 69% were male. With a median tumor size of 45 mm, no patient displayed metastatic dissemination at diagnosis. Time from transplantation to diagnosis was highly variable between 5 mo and 21 years. Histopathological data mostly revealed high risk of progression (43%). Death increased to 29% during follow-up. Surgical treatment was systematically performed when the tumor was operable (94%). The use of adjuvant therapy was uncommon (19%).
CONCLUSION GISTs represent rare but potentially severe malignant complication among transplant patients.
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Affiliation(s)
- Romain Stammler
- Department of Nephrology, Georges Pompidou European Hospital, Paris 75015, France
| | - Dany Anglicheau
- Department of Renal Transplantation, Necker-Enfants Malades Institute, French National Institutes of Health and Medical Research U1151, Paris 75015, France
- Université Paris Cité, Assistance Publique des Hôpitaux de Paris, Paris 75001, France
| | - Bruno Landi
- Université Paris Cité, Assistance Publique des Hôpitaux de Paris, Paris 75001, France
- Department of Gastroenterology and Digestive Oncology, Georges Pompidou European Hospital, Paris 75015, France
| | - Tchao Meatchi
- Department of Pathology, Georges Pompidou European Hospital, Paris 75015, France
| | - Emilia Ragot
- Department of Digestive Surgery, Georges Pompidou European Hospital, Paris 75015, France
| | - Eric Thervet
- Department of Nephrology, Georges Pompidou European Hospital, Paris 75015, France
- Université Paris Cité, Assistance Publique des Hôpitaux de Paris, Paris 75001, France
| | - Hélène Lazareth
- Department of Nephrology, Georges Pompidou European Hospital, Paris 75015, France
- Université Paris Cité, Assistance Publique des Hôpitaux de Paris, Paris 75001, France
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Small intestinal perforation due to a huge gastrointestinal stromal tumor in a kidney transplant recipient: a case report and literature review. BMC Nephrol 2019; 20:120. [PMID: 30943904 PMCID: PMC6448240 DOI: 10.1186/s12882-019-1310-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Accepted: 03/21/2019] [Indexed: 12/16/2022] Open
Abstract
Background Gastrointestinal stromal tumors (GISTs) in transplant recipients are very rare and only a handful of cases have been reported to date. Here we present the first known case of a huge GIST in a kidney transplant recipient with perforation of small intestine. Case presentation A 64-year-old male presented at our hospital with right colic pain; he had received an ABO incompatible kidney transplant 6 years earlier and was treated with cyclosporine, mycophenolate mofetil, and methylprednisolone. Radiological evaluation revealed a huge (11 cm in diameter) solitary tumor at the small intestine without distant metastasis. The small intestinal wall at the tumor location was perforated one week after diagnosis and the patient underwent emergency surgery. The pathological findings were compatible with GIST and the tumor consisted of spindle cells with positive staining for KIT, CD34, and DOG1 and negative or weak staining for desmin and S-100 protein. A mutation in exon 11 of the c-kit gene was also detected. Cyclosporine was withdrawn and imatinib mesylate (400 mg daily) was introduced. However, thereafter, we needed to decrease the dose at 300 mg daily due to severe hyponatremia. Reduced imatinib treatment was well tolerated and recurrence was not observed for 18 months after surgery. Conclusions The occurrence of GISTs in transplant patients is rare, and huge GISTs should be resected immediately after diagnosis because gastrointestinal tract at the tumor site could be perforated. Imatinib treatment is feasible in transplant recipients under immunosuppression, although immunosuppressive drugs metabolized by CYP3A4 should be used at a reduced dosage or withdrawn.
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Garrigós C, Espinosa M, Salinas A, Osman I, Medina R, Taron M, Molina-Pinelo S, Duran I. Single nucleotide polymorphisms as prognostic and predictive biomarkers in renal cell carcinoma. Oncotarget 2017; 8:106551-106564. [PMID: 29290970 PMCID: PMC5739755 DOI: 10.18632/oncotarget.22533] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2017] [Accepted: 10/25/2017] [Indexed: 11/25/2022] Open
Abstract
Despite major advances in the knowledge of the molecular basis of renal cell carcinoma, prognosis is still defined using clinical and pathological parameters. Moreover, no valid predictive biomarkers exist to help us selecting the best treatment for each patient. With these premises, we aimed to analyse the expression and to determine the prognostic and predictive value of 64 key single nucleotide polymorphisms in 18 genes related with angiogenesis or metabolism of antiangiogenics in two cohorts of patients with localized and advanced renal cell cancer treated at our institution. The presence of the selected single nucleotide polymorphisms was correlated with clinical features, disease free survival, overall survival and response rate. In patients with localized renal cell cancer, 5 of these polymorphisms in 3 genes involved in angiogenesis predicted for worse disease free survival (VEGFR2: rs10013228; PDGFRA: rs2228230) or shorter overall survival (VEGFR2: rs10013228; VEGFR3: rs6877011, rs307826) (p < 0.05). Rs2071559 in VEGFR2 showed a protective effect (p = 0.01). In the advanced setting, 5 SNPs determined inferior overall survival (IL8: rs2227543, PRKAR1B: rs9800958, PDGFRB: rs2302273; p = 0.05) or worse response rate (VEGFA: rs699947, rs3025010 p ≤ 0.01)). Additionally 1 single nucleotide polymorphism in VEGFB predicted for better response rate rs594942 (p = 0.03). Genetic analysis of renal cell carcinoma patients might provide valuable prognostic/predictive information. A set of SNPs in genes critical to angiogenesis and metabolism of antiangiogenics drugs seem to determine post-surgical outcomes and treatment response in our series.
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Affiliation(s)
- Carmen Garrigós
- Instituto de Biomedicina de Sevilla, IBiS, Hospital Universitario Virgen del Rocío, CSIC, Universidad de Sevilla, Sevilla, Spain
| | - Marta Espinosa
- Instituto de Biomedicina de Sevilla, IBiS, Hospital Universitario Virgen del Rocío, CSIC, Universidad de Sevilla, Sevilla, Spain
| | - Ana Salinas
- Instituto de Biomedicina de Sevilla, IBiS, Hospital Universitario Virgen del Rocío, CSIC, Universidad de Sevilla, Sevilla, Spain
| | - Ignacio Osman
- Unidad de Urología Oncológica, UGC Urología-Nefrología H.U.Virgen del Rocío, Instituto de Biomedicina de Sevilla, IBiS, Hospital Universitario Virgen del Rocío, CSIC, Universidad de Sevilla, Sevilla, Spain
| | - Rafael Medina
- Unidad de Urología Oncológica, UGC Urología-Nefrología H.U.Virgen del Rocío, Instituto de Biomedicina de Sevilla, IBiS, Hospital Universitario Virgen del Rocío, CSIC, Universidad de Sevilla, Sevilla, Spain
| | - Miguel Taron
- Instituto de Biomedicina de Sevilla, IBiS, Hospital Universitario Virgen del Rocío, CSIC, Universidad de Sevilla, Sevilla, Spain
| | - Sonia Molina-Pinelo
- Instituto de Biomedicina de Sevilla, IBiS, Hospital Universitario Virgen del Rocío, CSIC, Universidad de Sevilla, Sevilla, Spain.,Centro de Investigación Biomédica en Red Cáncer, CIBERONC, Madrid, Spain
| | - Ignacio Duran
- Instituto de Biomedicina de Sevilla, IBiS, Hospital Universitario Virgen del Rocío, CSIC, Universidad de Sevilla, Sevilla, Spain
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Xu CW, Lin S, Wang WL, Gao WB, Lv JY, Gao JS, Zhang LY, Li Y, Wang L, Zhang YP, Tian YW. Analysis of mutation of the c-Kit gene and PDGFRA in gastrointestinal stromal tumors. Exp Ther Med 2015; 10:1045-1051. [PMID: 26622437 DOI: 10.3892/etm.2015.2613] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Accepted: 05/18/2015] [Indexed: 01/19/2023] Open
Abstract
The aim of the present study was to investigate mutation status of the c-Kit gene (KIT) and PDGFRA in patients with a gastrointestinal stromal tumor (GIST). In total, 93 patients with a GIST were included in the study, in which polymerase chain reaction amplification and gene sequencing were used to detect the sequences of exons 9, 11, 13 and 17 in KIT and exons 12 and 18 in PDGFRA. KIT mutations were detected in 64 cases (68.82%), of which exon 11 mutations were detected in 56 cases (60.22%), exon 13 mutations were detected in three cases (3.23%) and one case (1.08%) was shown to have a mutation in exon 17. The most common mutation in exon 11 was a deletion, which accounted for 55.36% (31/56) of the cases, followed by a point mutation observed in 26.79% (15/56) of the cases, while an insertion (tandem repeats) was identified in 14.29% (8/56) of the cases, and 3.57% (2/56) of the exon 11 mutations were deletions associated with a point mutation. The majority of the mutations were heterozygous, with only a few homozygous mutations. Mutational analysis revealed the mutations to be more concentrated in the classic hot zone at the 5'-end, followed by the tandem repeat frame at the 3'-end. In four cases, a mutation was detected in exon 18 of PDGFRA, of which one was associated with a mutation in KIT. The remaining three cases (10.34%, 3/29) were not associated with mutations in KIT and accounted for 37.5% (3/8) of the CD117-negative GIST cases. Therefore, the majority of the GIST cases were characterized by mutations in KIT or PDGFRA, which were directly associated with the disease. Pairs of different mutations in the same exon of KIT, or KIT mutations coupled with pairs of mutations in PDGFRA, were detected in a small number of patients. Imatinib is a small molecule tyrosine kinase inhibitor and is the first line targeted treatment for GIST, resulting in markedly improved survival rates. Thus, gene mutation genotyping may provide inspiration and guidance for imatinib-based targeted cancer therapy.
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Affiliation(s)
- Chun-Wei Xu
- Department of Pathology, The General Military Hospital of Beijing PLA, Beijing 100700, P.R. China
| | - Shan Lin
- Department of Oncology, Affiliated Zhongshan Hospital of Dalian University, Dalian, Liaoning 116001, P.R. China
| | - Wu-Long Wang
- Department of Oncology, The Second Affiliated Hospital of Baotou Medical College, Baotou, Inner Mongolia 014030, P.R. China
| | - Wen-Bin Gao
- Department of Oncology, Affiliated Zhongshan Hospital of Dalian University, Dalian, Liaoning 116001, P.R. China
| | - Jin-Yan Lv
- Department of Oncology, Affiliated Zhongshan Hospital of Dalian University, Dalian, Liaoning 116001, P.R. China
| | - Jing-Shan Gao
- Department of Clinical Medicine, Dalian Medical University, Dalian, Liaoning 116044, P.R. China
| | - Li-Ying Zhang
- Department of Pathology, The General Military Hospital of Beijing PLA, Beijing 100700, P.R. China
| | - Yang Li
- Department of Oncology, The General Military Hospital of Beijing PLA, Beijing 100700, P.R. China
| | - Lin Wang
- Department of Pathology, Shanxi Da Hospital, Shanxi Academy of Medical Sciences, Taiyuan, Shanxi 030001, P.R. China
| | - Yu-Ping Zhang
- Department of Pathology, The People's Hospital of Weifang, Weifang, Shandong 261041, P.R. China
| | - Yu-Wang Tian
- Department of Pathology, The General Military Hospital of Beijing PLA, Beijing 100700, P.R. China
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Cimen S, Guler S, Panek R, Alwayn I. Gastrointestinal stromal tumour in a recipient with kidney transplantation. BMJ Case Rep 2015; 2015:bcr-2014-207178. [PMID: 26032701 DOI: 10.1136/bcr-2014-207178] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Immunosuppression is associated with an increased risk of post-transplant malignancies. Gastrointestinal stromal tumours are the most common mesenchymal tumours of the gastrointestinal tract. However, they have seldom been reported recipient with transplantation. In this report, a 46-year-old woman, a recipient with kidney transplantation, who developed a gastric tumour is presented. Removal of this tumour required a partial gastrectomy. Histopathology and immunohistochemistry examinations revealed a high-risk gastric stromal tumour. Adjuvant imatinib mesylate treatment was initiated. There was no evidence of tumour recurrence at 12-month follow-up.
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Affiliation(s)
- Sertac Cimen
- Department of Surgery, Dalhousie University, Halifax, Canada
| | - Sanem Guler
- Department of Surgery, Dalhousie University, Halifax, Canada
| | - Romuald Panek
- Department of Nephrology, Dalhousie University, Halifax, Canada
| | - Ian Alwayn
- Department of Surgery, Dalhousie University, Halifax, Canada
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