Background: The risk of developing primary tumors succeeding organ transplantation is significant. The transmission of cancer from organ donation, however, is rare, with sporadic cases being reported. In these scenarios, the common features are primary cancers in the transplanted organs or metastasis from tumors with high propensity to spread to these organs.
Case report: We report a case of a black female patient, 30 years old, who had Mayer-Rokitansky-Küster-Hauser syndrome and chronic kidney disease, resulting from multiple urinary tract infections. In July 2016, after five years of hemodialysis, she underwent a kidney transplant from a deceased donor. In March 2017, a biopsy of the transplanted kidney was done, due to renal failure. The biopsy suggested a poorly differentiated carcinoma, with probable pancreatobiliary origin (Immunohistochemistry: AE1/AE3, CK7, CDX2, 34bE12 positive and CK20, TTF1, estrogen receptor, p63, BRST negative). Extrarenal disease was not found by staging images. On April 24th, 2017, nephroureterectomy and lymphadenectomy were performed, with the pathology confirming pancreatobiliary carcinoma. She returned to hemodialysis sessions. After 6 months of surveillance, local recurrence as a mass in the right iliac fossa was detected. Following three cycles of carboplatin + gemcitabine, a complete metabolic response was observed in PET scan and chemotherapy was stopped due to hematologic toxicity. Currently, the patient is still under surveillance, with no evidence of invasive disease. Considering the time elapsed from organ transplantation and cancer development in this report, it is expected that the neoplasm was transmitted from the donor. Most of these cases have deceased donors. In the absence of a macroscopic primary tumor, it is difficult to hypothesize that there was contiguous invasion. Despite of the rarity of renal metastasis from primary pancreatobiliary cancers, we considered this justification for the case.
Conclusion: This is a case report of cancer transmission from kidney transplant, with uncommon metastasis site from the suggested primary tumor. Considering the unfeasibility to prospective trials and the rarity of these cases, this kind of reports are crucial.