BK virus-associated collecting duct carcinoma of the renal allograft in a kidney-pancreas allograft recipient

Abstract

BK polyomavirus (BKV) nephropathy is a major concern in renal transplantation. Its main consequence is graft loss, which occurs in more than 50% of the cases. De novo renal cell carcinoma in renal allograft is a very rare event. Most of these tumors are papillary or clear cell carcinomas. We report herein the first case of collecting duct carcinoma of the renal allograft in a kidney-pancreas allograft adult recipient. Collecting duct carcinoma occurs long after the cure of a BKV nephropathy. At this time, BKV viremia and viruria were negative as well as the immunostaining for SV40 in the non-tumor kidney. The viral oncoprotein Tag persists only in the tumor cells. To preserve pancreas graft function, we maintained immunosuppression levels. After a 9-months follow-up, the evolution was free from clinical and radiological progression. The oncogenic role of BKV remains controversial in human cancers. However, strong experimental data have shown an association between BKV infection and urologic neoplasms. Further works might precise the exact role of polyomaviruses in renal carcinogenesis. In the meantime, clinical vigilance for early diagnostic of these tumors is mandatory after BKV nephropathy.

Immunologic Clearance of a BK Virus-associated Metastatic Renal Allograft Carcinoma

“…25 Overall, our observations are consistent with a role of BKPyV in the development of urologic tract malignancies in transplanted patients and further supports growing evidence. 5,[10][11][12][13]25 To our view, the lesson from this case is the importance of BKPyV screening and we would advocate a higher index of suspicion for urinary tract malignancies in patients with a former BKPyV infection. 26 While our data and those of others highly suggest an oncogenic role of the BKPyV, we think that, paradoxically, BKPyV may also participate to tumor clearance be it due to lytic replication or due to the HLA-class I presentation of viral antigens, 23 as is the case for…”

“…8,9 Over the past few years, it has been hypothesized that renal cell and collecting duct carcinomas could be linked to BK polyomavirus (BKPyV) in transplanted patients. 5,[10][11][12][13][14] BKPyV-associated nephropathy complicates 8% (range 1% to 15%) of kidney transplant recipients causing premature graft loss in 10% to 50% of cases. 15 We report the successful management of a kidney-pancreas recipient who developed de novo multimetastatic donor-derived collecting duct carcinoma.…”

Persistent BK polyomavirus‐DNAemia may warrant cystoscopy to rule out urologic carcinoma: A case report and review of the literature

“…These differences in outcome may very well be explained by the different methods of detection used, ranging from BKPyV‐LTAG, NCCR, VP1 PCRs to SV40 LTAg antibody staining on paraffin sections, and Papanicolaou staining on urine cytology specimens. Recently published reports also suggest a “two‐hit” hypothesis where the BKPyV cell affects the CD cells and another undefined insult then results in the development of cancer 43 . Recently, a novel BK‐polyomavirus strain, CH‐1, was shown to integrate into exon 26 of the myosin‐binding protein C1 gene (MYBPC1) on chromosome 12 in tumor cells, but not in normal renal cells, using throughput DNA sequencing from a urothelial carcinoma arising from a renal allograft 35 .…”

Unusual BK polyomavirus‐associated urologic malignancies in renal transplant recipients: Report of two cases and review of the literature

“…However, the most serious complication of BKV in these patients is the development of urologic malignancies. Fortunately, such complications are rare and only 36 cases of urothelial carcinoma (UC) (Table ), and several renal cell carcinomas, including collecting duct carcinomas were reported to date …”