Incidentally Detected Malignancies in Lung Explants: Single Center Case Series
Thoracic Surgery and Lung Transplantation, Norton Thoracic Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ
Meeting: 2021 American Transplant Congress
Abstract number: LB 89
Keywords: Graft survival, Lung transplantation, Malignancy, Post-transplant malignancy
Topic: Clinical Science » Lung » Lung: All Topics
Session Information
Session Name: Lung: All Topics
Session Type: Poster Abstract
Session Date & Time: None. Available on demand.
Location: Virtual
*Purpose: Thoracic malignancies are difficult to prospectively diagnose in patients with end-stage lung disease due to complex radiologic features. We present a series of lung transplant (LTx) recipients with incidentally diagnosed malignancies in native lung explants.
*Methods: For this retrospective series, we reviewed our LTx registry over 10 years (2011-2020) for malignancy on the lung explant. Histopathology, computed tomography (CT), and positron emission tomography (PET) scans were recorded. Before LTx, a new or expanding pulmonary nodule (PN) was defined as a CT correlative lesion. Endpoints were survival, acute cellular rejection (ACR), and antibody-mediated rejection (AMR).
*Results: Of 855 LTx recipients during the study period, 1.3% (n=11) had an explant malignancy. The median age was 68 years, and 55% (n=6) were ex-smokers (median, 25 pack-years). A CT correlative lesion was present in 3 patients; PET demonstrated a metabolically inactive PN in 2 of the patients, and a biopsy in the third suggested coccidiomycosis. The median (range) time between CT and LTx was 58 (16-414) days. All LTx were bilateral. The predominant explant histology was adenocarcinoma (AC; Table 1). The median (range) tumor size was 2.7 (0.4-19) cm. Nodal involvement was seen in 36% (N1 in 3 patients and N2 in 1). Mycophenolate mofetil was stepped down in all patients, and everolimus was used in 18% (n=2) of patients. Cisplatin and pemetrexed chemotherapy was used in 2 patients, and palliative radiation in 2. ACR was present in 27% (n=3) of patients and AMR was treated in 18% (n=2). Overall, 55% (n=6) of patients were alive, 45% (n=5) of whom were cancer-free (CF). Mean survival was 26±25 months.
| Patient | Lung disease | Explant histology | Stage | Alive | Survival (mo) | Outcome/cause of death |
| 1 | COPD | Invasive AC | IIA | No | 48 | M |
| 2 | COPD | AC (acinar) | IB | Yes | 86 | CF, ACR |
| 3 | COPD | Invasive AC (papillary) | IB | Yes | 24 | CF |
| 4 | COPD | Keratinizing SCC | IA1 | Yes | 5 | CF |
| 5 | IPF | AC | IA1 | No | 7 | Failure to thrive |
| 6 | IPF | AC (papillary) | IIB | No | 48 | M, ACR |
| 7 | IPF | Invasive AC (lepidic), in AC in situ | IIIA | No | 5 | M |
| 8 | IPF | Follicular lymphoma | Low grade | Yes | 31 | CF |
| 9 | IPF | Invasive nonmucinous AC (lepidic) | IIB | Yes | 9 | CF |
| 10 | CPFE | AC (acinar, micropapillary) | IIIB | Yes | 13 | M, AMR |
| 11 | CPFE | Invasive AC (acinar, lepidic) | IIIA | No | 12 | M, ACR, AMR |
*Conclusions: Explanted native lungs can have incidentally detected primary malignancy. Pneumonectomy was curative in squamous cell carcinoma (SCC) and lymphoproliferative disorders. For AC, metastases (M) and allograft rejection from changes in immunosuppression were major causes of a guarded prognosis. Recipients with explant cancers ≥ stage III had poor short-term survival.
To cite this abstract in AMA style:
Razia D, Arjuna A, Schaheen L, Huang J, Smith M, Bremner R, Walia R. Incidentally Detected Malignancies in Lung Explants: Single Center Case Series [abstract]. Am J Transplant. 2021; 21 (suppl 3). https://atcmeetingabstracts.com/abstract/incidentally-detected-malignancies-in-lung-explants-single-center-case-series/. Accessed October 30, 2024.« Back to 2021 American Transplant Congress