A 71-year-old woman was transplanted for primary biliary cholangitis (PBC) in 2006, with graft function that was persistently normal during follow-up, as well as normal liver stiffness (FibroscanⓇ) and abdominal doppler ultrasound. Immunosuppression was CNI-based (tacrolimus, blood level=4 µg/L) and everolimus (blood level 2.3 µg/L) added-on in 2014 (diagnosis of PTLD TCD8+, CD 30-, BOM negative). In December 2019, the patient presented with the appearance of a diffuse arthro-myalgia; pancytopenia; abnormal alkaline phosphatase and Gamma-glutamyl-transferase (364/231 IU/L). Thus, a liver biopsy was performed in January 2020. Histology revealed a diffuse hepatic infiltration of high-grade neuroendocrine carcinoma (NEC) showing high proliferation-index (Ki-67 80%) (Fig. 1) [
]. A disease staging by imaging included: 1-TC-scan showing thoracic-axillary-abdominal adenopathies; an inhomogeneous colliquated lesion (6 cm) in mediastinal region; an inhomogeneous liver graft with multiple hypodense areas and lumpy margins; 2- A PET-TC revealed the presence of high glucose metabolic activity of hetero-productive significance of the mediastinal lesion; multiple lymphadenopathies; diffuse similar activity in the liver and at the medullary level (Fig. 2); 3- EGD: microfoci of neoplastic infiltration of the gastric lamina propria; 4- A Bone marrow aspirate/biopsy showed massive infiltration of NEC, as also was shown by fine-needle aspiration of the mediastinal lesion and axillary lymph node, with probable pulmonary primitivity. The oncological program including mutational characteristics of the neoplasm was started but not concluded after hospital discharge. In fact, at the end of March 2020 the patient developed a severe respiratory failure and died from Covid-19 infection.
- Colmenero J
- Tabrizian P
- Bhangui P
- Pinato DJ
- Rodríguez-Perálvarez ML
- Sapisochin G
- Bhoori S
- Pascual S
- Senzolo M
- Al-Adra D
- Herrero JI
- Petrowsky H
- Dawson LA
- Hosni A
- Kutzke JL
- Gastaca M
- Watt KD.
De Novo malignancy after liver transplantation: risk assessment, prevention, and management-guidelines from the ILTS-SETH consensus conference.
Transplantation. 2022 Jan 1; 106: e30-e45https://doi.org/10.1097/TP.0000000000003998
Abbreviations:PET (positron emission tomography), CT (computed tomography), CNI (calcineurin inhibitors), EGD (esophagogastroduodenoscopy), PTLD (post-transplant lymphoproliferative disorder), COVID-19 (Coronavirus disease 2019)
To read this article in full you will need to make a payment
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to Digestive and Liver Disease
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- De Novo malignancy after liver transplantation: risk assessment, prevention, and management-guidelines from the ILTS-SETH consensus conference.Transplantation. 2022 Jan 1; 106: e30-e45https://doi.org/10.1097/TP.0000000000003998
Published online: March 05, 2023
Accepted: February 20, 2023
Received: December 10, 2022
Publication stageIn Press Corrected Proof
© 2023 Published by Elsevier Ltd on behalf of Editrice Gastroenterologica Italiana S.r.l.