2-Deoxy-2-[F-18]fluoro-D-glucose positron emission tomography illustrates two visceral tumors in a post kidney transplant patient with multiple cutaneous malignancies.

The success of renal transplantation brings with it the dilemma of managing patients with complications from lifelong immunosuppressive therapy. Immunosuppressed transplant recipients are a special population with significantly increased risk for development of skin cancers. Because malignant tumors are increasing as demonstrated on 2-deoxy-2-[F-18]fluoro-D-glucose (FDG) positron emission tomography (PET) image, we report the unusual coincidence of multiple cutaneous cancers and two visceral malignancies 20 years after renal transplantation. The malignancies include basal cell and squamous cell carcinomas and malignant fibrous histiocytoma. FDG-PET images show, in this case, visceral masses with increased metabolism: one in the left upper lung and one in the abdomen, corresponding to individual mass lesions observed on computed tomography (CT) images of the chest and abdomen. A fine-needle biopsy of the nodule of the left upper lung lobe yielded a diagnosis of a sarcoma. The mass lesion of the abdomen had caused bowel obstruction, requiring exploratory laparotomy; histopathological findings from the resected mass from the abdomen confirmed the diagnosis malignant fibrous histiocytoma. This long-term immune suppressed transplant recipient developed viscerally located malignant lesions demonstrated by FDG-PET imaging and three types of cutaneous malignancies (skin cancers).