外文文献汇报模板PPT精选文档

CASEREPORTTransmissionofbreastcancerbyasinglemultiorgandonorto4transplantrecipientsLiteraturesSourceAmericanjournaloftransplantationYvetteA.H.Matser1| MattyL.Terpstra2| SilvioNadalin3| GeorgeD.Nossent4|JandeBoer5| BarbaraC.vanBemmel6| SusannevanEeden7| KlemensBudde8|SusanneBrakemeier8| FrederikeJ.Bemelman2AuthorIF:6.4931、INTRODUCTIONThiscasereportdescribesthetransmissionofbreastcancerfromasingleorgandonorto4recipientsmanyyearsafterdonation.Atthetimeofdonation,itwasunknownthatthedonorsufferedfromamalignancy.2、CASEREPORTThe53-year-olddonorinthiscasehadnorelevantmedicalhistoryanddonatedherkidneys,lungs,liver.Theother4recipientsdevelopeddonor-derivedbreastcancer(provenbyDNAmicrosatellite)within16monthsto6yearsaftertransplantation.Unfortunately,thedouble-lungrecipient,left-kidneyrecipient,andliverrecipientdiedduetothedonor-derivedbreastcancer.Theright-kidneyrecipientremainsalive.Afterthediagnosisofbreastcancerinthetransplantedkidney,thepatientunderwenttransplantnephrectomy,hisimmunosuppressionwasstopped,chemotherapywasinitiated,andheachievedcompleteremissiondespitewidelymetastasizeddisease.FIGURE 11①、Double-lungrecipientThelungswereallocatedtoa42-year-oldfemalewhosufferedfromend-stagelungdiseaseduetosarcoidosiswithremittingpneumothoraces.InAugust2008(16monthsaftertransplantation),thepatientwasadmittedtothehospitalbecauseoftransplantdysfunction.AchestX-rayshowedmediastinallymphadenopathy.Amediastinallymphnodebiopsyshowedestrogenreceptorandprogesterone-receptorpositive(ER+,PR+)adenocarcinoma.TheFES-PETscanrevealedabnormalitiesinthelungsandbones.Thepatient’simmunosuppressionwasreduced.InSeptember,aCTscanshowedlesionsintheliverandbonesthatwerecompatiblewithmetastases.Sixmonthslater,shepresentedwithincreasingthoracicpain,hypercalcemia,andrenalinsufficiency.InAugust2009,palliativecarewasstarted,andafterafewdays,thepatientpassedaway.Extensiveresearchwith5independentDNAmicrosatellitemarkersrevealedthatthisbreastcancerwasdonorderived.②、Left-kidneyrecipienTheleft-kidneyrecipientwasa62-year-oldfemale.SheunderwentapostmortemdonorkidneytransplantationinApril2007underhighlyurgentstatusbecauseofanimminentlackofvascularaccess,whichwaslimitingdialysisoptions.WhenEurotransplantreportedthedeathofthelungrecipientin2010duetodonor-derivedmetastaticbreastcancer,thesituationwasdiscussedwiththepatient.Itseemedthatremovalofthetransplantwasnotanoptionbecauseofalackofaccess.ACTscanofthetransplantedkidneywasperformed,whichmajorpathology.Prophylacticantihormonaltreatmentwasconsidered.However,becausetherewerenodataintheliteraturesupportingthistreatment,itwasfinallydecidednottostartantihormonaldrugs.Fiveyearslater,thepatientpresentedwithhypercalcemia,weightloss,andmalaise.ACTscanoftheabdomenshowedmultiplelesionsintheliver.AliverbiopsyrevealedER+,PR+adenocarcinoma,whichappearedtohavespreadtothekidney,liver,bone.③、LiverrecipientThelivergraftwasallocatedtoa59-year-oldfemalerecipientsufferingfromdecompensatedprimarybiliarycirrhosis.Fouryearslater(in2011),atumorwasdetectedinsegmentVIIIofthelivergraftandhistologicallyproventobedonor-derivedmetastasizedER+breastcancer.Aretransplantationwasimmediatelyproposedtotherecipient,whichsherefused.Shefeltwellandwasafraidofpotentialpostoperativecomplicationsshehadexperiencedin2007afterthelivertransplantation.Shedecidedtoundergoanablativeprocedurebymeansofextracorporealprotonradiationatanothercenter,andtherewereradiologicalsignsofcompleteresponse.Afteralong-termstabledisease,in2014(7yearsafterthetransplant),thepatientdevelopedextrahepatictumorprogressionthatwasmainlylocalizedatthehilarregion.Sherefusedanyfurtheroncologicaltreatmentanddiedafewmonthslaterduetodiffusetumorprogression.④、Right-kidneyrecipientA32-year-oldmalereceivedtherightkidney.Afterhewasinformedofthetransmissionofbreastcancertothelungrecipientin2010,regulartumorscreeninginvestigationswereperformed,includingachestX-rayandultrasoundoftheabdomen.Inaddition,aCTscanofthechestwasperformedinJanuary2011.Allofthefindingswereunremarkable.InJuly2011,thepatientdevelopedmassiveproteinuria(3g/d),andantibody-mediatedrejectionwassuspectedduetoweakHLA-classIIantibodies.AbiopsyshowedwidespreadinvasionoftherenalallograftbyER+,PR+adenocarcinoma,whichappearedtobehumanepidermalgrowthfactorreceptor2positive.ACTscanofthetransplantedkidneyrevealedseveralfocalhypodenseareasandaheterogeneouscortex.4、 DISCUSSIONIt'snotthefirsttimethatacancerhasmetastasizedbetweenanorgandonorandanorganrecipient,buttheoddsofthathappeningareverylow,somewherebetween1in10,000and5in10,000,andinthiscase,it'sthefirsttimeadonorhastransferredcancercellstofourreceptors.Whywouldapersonwhoshowsnosignsofcancer"infect"organrecipientsafteranorgantransplant?Whydopatientswithdifferentorganshavethesamekindofcancer?Atpresent,theresearchershaveonlysomespeculationaboutthecause,thedefinitivereasonisunknown.Onehypothesisisthatdonorbreastcancerhasmetastasizedormetastasizedineverytransplantorgan,andpreviousstudieshaveshownthatcirculatingtumorcellswerefoundinthefirststageofbreastcancer.Recipientsoforgantransplantsrequirelong-termuseofimmunosuppressants,whichallowcancercellsinorgansthatdonotnormallydevelop.Anotherpossiblereasonisthatischemia-reperfusioninjuryassociatedwithorgantransplantationmaystimulatetheexpressionoftumorcells.5、summaryAtpresent,fororgantransplanters,whattheycandoistohaveregularphysicalexamination.Oncethe"metastatic"cancerappears,theyshouldtrytoremovethetransplantedorgans,removetheimmunesuppression,andconductactivecancertreatment.