TY - JOUR
T1 - A liver nodule in a patient transplanted for primary sclerosing cholangitis
T2 - an interdisciplinary diagnostic approach
AU - Loosen, Sven Heiko
AU - Schmeding, Maximilian
AU - Roderburg, Christoph
AU - Binneboesel, Marcel
AU - Temizel, Ilknur
AU - Mottaghy, Felix M.
AU - Tischendorf, Jens J. W.
AU - Tacke, Frank
AU - Gaisa, Nadine T.
AU - Hussein, Kais
AU - Lehmann, Ulrich
AU - Trautwein, Christian
AU - Neumann, Ulf Peter
AU - Luedde, Tom
PY - 2017/1
Y1 - 2017/1
N2 - 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 x 23mm was detected in the transplanted liver. This lesion had not been noticed immediately after transplantation and showed a pattern suspicious for malignancy in contrastenhanced 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 subse-quently 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.
AB - 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 x 23mm was detected in the transplanted liver. This lesion had not been noticed immediately after transplantation and showed a pattern suspicious for malignancy in contrastenhanced 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 subse-quently 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.
KW - contrast-enhanced ultrasound
KW - liver transplantation
KW - marginal donors
KW - primary sclerosing cholangitis (PSC)
KW - ulcerative colitis (UC)
KW - FISH
KW - INFLAMMATORY-BOWEL-DISEASE
KW - DOSE URSODEOXYCHOLIC ACID
KW - ULCERATIVE-COLITIS
KW - COLORECTAL NEOPLASIA
KW - NATURAL-HISTORY
KW - COLONIC NEOPLASIA
KW - CANCER
KW - RISK
KW - DYSPLASIA
KW - DONOR
U2 - 10.1055/s-0042-111048
DO - 10.1055/s-0042-111048
M3 - Article
SN - 0044-2771
VL - 55
SP - 56
EP - 62
JO - Zeitschrift für Gastroenterologie
JF - Zeitschrift für Gastroenterologie
IS - 1
ER -