Albino Eccher1, Luigino Boschiero2, Francesca Fior2, Marilena Casartelli Liviero3, Laura Zampicini3, Claudio Ghimenton1, Antonietta D'Errico-Grigioni4, Anna Caliò5, Guido Martignoni5, Brett Delahunt6, Matteo Brunelli5. 1. DAI Pathology and Diagnostics, Azienda Ospedaliera Universitaria Integrata (AOUI) University Hospital, Verona, Italy. 2. Kidney Transplant Center, Surgery Unit, Azienda Ospedaliera Universitaria Integrata (AOUI) University Hospital, Verona, Italy. 3. Neurosurgery and Intensive Care Unit, Azienda Ospedaliera Universitaria Integrata (AOUI) University Hospital, Verona, Italy. 4. Department of Pathology, University of Bologna, Bologna, Italy. 5. Department of Pathology and Diagnostics, University of Verona, Verona, Italy. 6. Department of Pathology and Molecular Medicine, Wellington School of Medicine and Health Sciences, University of Otago, Wellington, New Zealand.
Abstract
BACKGROUND: Kidneys with single or multiple tumors, provided that they have histological features recognized as being associated with low risk of recurrence, are considered suitable for transplantation. It is known that kidneys with multiple primary renal tumors show poor renal function and that function dramatically declines when tumors have a miliary configuration. Despite this, no guidelines are in place to differentiate between multifocal tumors and those that are miliary in nature. CASE REPORT: We report a case in which initial examination revealed papillary renal cell neoplasia in deceased donor kidneys, which were later confirmed on histological and genetic testing to be multiple and miliary in distribution. Gross examination showed closely opposed neoplasms, and on histological examination these were found to be papillary renal cell carcinomas and renal papillary adenomas. This ultimately led to the decision that both kidneys were unsuitable for transplantation. CONCLUSIONS: At present there are no recommendations as to how tumor-bearing donor kidneys should be handled in order to determine if miliary neoplasia is present. From our case it is apparent that, in addition to obvious tumor nodules, at least 3 samples of cortex should be examined. This case highlights the important role of the pathologist in assessing donor kidneys with evidence of neoplasia.
BACKGROUND: Kidneys with single or multiple tumors, provided that they have histological features recognized as being associated with low risk of recurrence, are considered suitable for transplantation. It is known that kidneys with multiple primary renal tumors show poor renal function and that function dramatically declines when tumors have a miliary configuration. Despite this, no guidelines are in place to differentiate between multifocal tumors and those that are miliary in nature. CASE REPORT: We report a case in which initial examination revealed papillary renal cell neoplasia in deceased donor kidneys, which were later confirmed on histological and genetic testing to be multiple and miliary in distribution. Gross examination showed closely opposed neoplasms, and on histological examination these were found to be papillary renal cell carcinomas and renal papillary adenomas. This ultimately led to the decision that both kidneys were unsuitable for transplantation. CONCLUSIONS: At present there are no recommendations as to how tumor-bearing donor kidneys should be handled in order to determine if miliary neoplasia is present. From our case it is apparent that, in addition to obvious tumor nodules, at least 3 samples of cortex should be examined. This case highlights the important role of the pathologist in assessing donor kidneys with evidence of neoplasia.
Authors: Albino Eccher; Amedeo Carraro; Ilaria Girolami; Manuela Villanova; Alex Borin; Paola Violi; Barbara Paro; Claudia Mescoli; Deborah Malvi; Luca Novelli; Antonietta D'Errico; Giuseppe Rossini; Marco Ungari Journal: Am J Case Rep Date: 2021-02-13