RESUMO
We report 4 cases of breast cancer transmission to transplant recipients from a single organ donor that occurred years after donation. The diagnosis of breast cancer was occult at the time of donation. All of the recipients developed a histologically similar type of breast cancer within 16 months to 6 years after transplantation. Three out of 4 recipients died as a result of widely metastasized disease. One of the recipients survived after transplant nephrectomy followed by cessation of immunosuppression and chemotherapy. This extraordinary case points out the often fatal consequences of donor-derived breast cancer and suggests that removal of the donor organ and restoration of immunity can induce complete remission.
Assuntos
Neoplasias da Mama/etiologia , Transplante de Rim/efeitos adversos , Transplante de Fígado/efeitos adversos , Transplante de Pulmão/efeitos adversos , Doadores de Tecidos , Adulto , Neoplasias da Mama/fisiopatologia , Neoplasias da Mama/terapia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , TransplantadosRESUMO
Besides periprosthetic joint infection, metal hypersensitivity should be considered when complaints persist after total joint arthroplasty. To date, there is no consensus on the diagnosis, and believers and non-believers of metal hypersensitivity exist. The pathogenesis of metal hypersensitivity is complex and involves a type-4 delayed hypersensitivity reaction with both a cutaneous and systemic response. It is unclear if complaints after total joint arthroplasty (after eliminating other causes) are caused by metal hypersensitivity. Furthermore, it is not known whether sensitization is a cause or a consequence of complaints after total joint arthroplasty. Currently, the patch test is the best screening test to diagnose metal hypersensitivity, but the accuracy has not been defined. We present a female patient with a painful left elbow three years after total elbow replacement. Because of the increasing volume of total joint prostheses, we aim to create awareness for metal hypersensitivity and the according diagnostic dilemmas.
Assuntos
Artroplastia do Joelho , Hipersensibilidade , Prótese Articular , Humanos , Feminino , Artroplastia do Joelho/efeitos adversos , Hipersensibilidade/diagnóstico , Hipersensibilidade/etiologia , Metais , Prótese Articular/efeitos adversos , DorRESUMO
Besides periprosthetic joint infection, metal hypersensitivity should be considered when complaints persist after total joint arthroplasty. To date, there is no consensus on the diagnosis, and believers and non-believers of metal hypersensitivity exist. The pathogenesis of metal hypersensitivity is complex and involves a type-4 delayed hypersensitivity reaction with both a cutaneous and systemic response. It is unclear if complaints after total joint arthroplasty (after eliminating other causes) are caused by metal hypersensitivity. Furthermore, it is not known whether sensitization is a cause or a consequence of complaints after total joint arthroplasty. Currently, the patch test is the best screening test to diagnose metal hypersensitivity, but the accuracy has not been defined. We present a female patient with a painful left elbow three years after total elbow replacement. Because of the increasing volume of total joint prostheses, we aim to create awareness for metal hypersensitivity and the according diagnostic dilemmas.
Assuntos
Artroplastia do Joelho , Hipersensibilidade , Prótese Articular , Humanos , Feminino , Artroplastia do Joelho/efeitos adversos , Hipersensibilidade/diagnóstico , Hipersensibilidade/etiologia , Metais , Prótese Articular/efeitos adversos , DorRESUMO
BACKGROUND: Chronic immunosuppression after solid-organ transplantation is a risk factor for cutaneous squamous cell carcinoma (cSCC) development. Certain immunosuppressant drugs, namely azathioprine and calcineurin inhibitors, increase this risk more than others. We investigated incidence of cSCC in a Dutch lung transplant recipient (LTR) cohort and analyzed associated risk factors. METHODS: All LTRs with post-transplant survival of >30 days were included. Data included indication for lung transplantation and duration of medication use. Skin cancer data were extracted from the Dutch nationwide registry of histopathology (PALGA). Uni- and multivariable hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using Cox proportional hazards regression analyses. RESULTS: Five hundred forty-four patients were included with a median survival of 11.05 years. Fifty-two (9.6%) LTRs developed at least one cSCC, with a cumulative incidence of 3.9% and 15.3% after 5 and 10 years, respectively. Multivariate analyses showed that the sequential use of azathioprine and mycophenolate mofetil (MMF), both at for least 1 year, was associated with a lower risk of developing cSCC (hazard ratio [HR] 0.24; 95% confidence interval [CI] 0.10 to 0.56) compared with azathioprine use only. Furthermore, age at transplantation (HR 3.42; 95% CI 1.33 to 8.79), male gender (HR 1.75; 95% CI 1.00 to 3.05), previous skin cancer (HR 4.75; 95% CI 1.14 to 19.76), and history of smoking (HR 3.30; 95% CI 1.69 to 6.44) were associated with increased risk of developing cSCC in univariate analyses. CONCLUSIONS: Apart from known risk factors, we found that switching from azathioprine to MMF is associated with reduced incidence of cSCC in LTR, prompting a discussion of whether switching azathioprine to MMF should be considered in high-risk patients.