Sclerosing angiomatoid nodular transformation of the spleen presenting as a rapidly growing tumour in a patient with rectal cancer.

A patient with rectal cancer developed a rapidly growing splenic mass 2 years after cancer treatment. Since a metastatic process could not be ruled out, splenectomy was performed, and the tumour emerged as a sclerosing angiomatoid nodular transformation (SANT) of the spleen. SANT is a rare, recently recognised, non-neoplastic vascular lesion of the spleen that radiologically may be difficult to distinguish from vascular splenic lesions such as splenic hamartoma, haemangioma or littoral cell angioma. However, morphologically and immunohistochemically it is separated from those tumours by its unique nodular angiomatoid proliferation pattern. SANT is considered to be a benign lesion. This case is reported because of its important clinical impact for the differential diagnosis of splenic masses. Data regarding growth rates of these lesions are scarce and a growth progression as in this case, that finally led to the indication for splenectomy due to lingering suspicion of malignancy, is novel.

Donor transmitted anaplastic carcinoma in a kidney-transplant recipient.

With the more frequent use of organs from elderly donors, the risk of transmitting tumor cells to the recipient increases. We report a case in which anaplastic carcinoma tumor cells from an organ-donor were transmitted to a kidney transplantation recipient. The donor's metastatic disease was discovered 7 days after harvest of the kidney following a brain biopsy undertaken at admission of the donor. The risk of transmitting the disease was generally estimated as so small that the excellently functioning kidney was not removed. Twelve weeks later, however, malignant cells were found in a biopsy of the transplanted kidney. The organ was removed immediately, but the intraoperative situs showed advanced disease with lymph-node-metastasis. Twelve months later no tumor progress could be detected. This case shows that there is considerable risk of transmitting formerly undetected cancer in elderly donors. Autopsies of donors who are older than 60 years of age should be routinely performed after organ donation.

Successful renal transplantation after intimal dissection of the renal artery secondary to trauma.

BACKGROUND: Organ shortage increasingly forces surgeons to consider the use of marginal organs. METHODS: The authors report a case in which a kidney with traumatic dissection of the renal artery and marginal perfusion by means of collaterals was successfully transplanted into a 63-year-old patient. A computed tomographic scan of the donor showed a marginally perfused left kidney, suggestive of renal artery dissection. After surgical reconstruction of the renal artery, transplantation followed the usual course. RESULTS: The organ started clearing shortly after the operation and was homogeneously perfused in a postoperative scan. Creatinine and blood urea nitrogen levels dropped to normal values within a couple of days after the transplantation. During 1 year of follow-up, organ function was always excellent and retention parameters were within the normal range. CONCLUSIONS: This case illustrates that marginally perfused kidneys can be successfully used for transplantation in certain cases.

Busulfan depletes neutrophils and delays accelerated acute rejection of discordant xenografts in the guinea pig-to-rat model.

Complement factor C6 plays a critical role in mediating hyperacute rejection of discordant xenografts. In order to explore the mechanism of discordant xenograft rejection, we investigated kinetics and phenotypes of the cellular infiltrate in xenografts in untreated and leukocyte-depleted recipients, in relation to graft survival. Guinea pig cardiac xenografts were heterotopically transplanted to totally C6-deficient PVG (C-) rats. Grafts were removed after 0, 6, 12, and 24 h ( n = 6). Histological evaluation was performed with hematoxylin and eosin (H & E) and immunoperoxidase staining. The agents fucoidin and busulfan were applied to delay xenograft rejection further. Within 6 h, minimal perivascular edema with isolated infiltrating CD11b/c- and ED1-positive cells were found. An intense infiltration of CD11b/c- and ED1-positive cells with interstitial hemorrhage was present after 24 h, though with little CD161 and CD3 cell infiltration. Inhibition of cell adhesion by fucoidin did not prolong xenograft survival (34 +/- 15 h, n = 4, P<0.47), but the depletion of granulocytes by injection of busulfan did prolong survival of the discordant xenografts, to 62 +/- 22 h ( n = 7, P < or = 0.0039). These results demonstrate a significant effect of specific depletion of granulocytes and macrophages by busulfan therapy on guinea pig cardiac xenograft survival in PVG (C-) rats, suggesting the participation of these infiltrating cells in the xenoreactive rejection process.