Malignant Fibrous Histiocytoma and Atypical Fibroxanthoma in Renal Transplant Recipients

Abstract

Background: Allograft recipients are at increased risk for skin cancer. The incidence of cutaneous squamous cell carcinoma is 50–250 times higher than in the age-matched control population, and basal cell carcinoma is about 10 times more frequent. The incidence of Kaposi’s sarcoma is increased 400 to 500 times over that in a control population of the same ethnic origin. However, the incidence of other types of cutaneous sarcoma in organ allograft recipients is largely unknown. Clinical Observation: Within a 2-year-period, we observed 2 patients with cutaneous malignant fibrous histiocytoma and 1 patient with atypical fibroxanthoma among a cohort of 642 renal transplant recipients. For comparison, the incidence for dermatofibrosarcoma protuberans which is the commonest type of cutaneous sarcoma, is 0.45/100,000 persons/year in the non-immunocompromised population. Our observation represents an incidence of 156/100,000/ year (95% confidence intervaI Cl 28–489/100,000/year) for cutaneous malignant fibrous histiocytoma and of 78/100,000/year (95% CI 4–368/ 100,000/year) for atypical fibroxanthoma. Conclusion: To our knowledge, this is the first report on an elevated incidence of cutaneous malignant fibrous histiocytoma and of atypical fibroxanthoma in renal transplant recipients. Future cohort studies on malignancies in organ allograft recipients should aim at defining this risk more exactly.

Atypical Fibroxanthoma: A case series and review of literature

“…Although actinic damage induced by UV radiation is considered to be the major causative factor, other possible risk factors include immunosuppression, Xray radiation, skin trauma [7] and other underlying skin disorders such as xeroderma pigmentosa [8]. Interestingly, amongst the transplant population the incidence of AFX has been recorded as high as 78 per 100,000 patients [9].…”

Atypical Fibroxanthoma

“…Radiation therapy and local skin trauma are other possible factors in the etiology of AFX. Out of 642 kidney transplant patients, two malignant fibrous histiocytomas and one AFX cases were detected and immunosuppression was thought to play a role in occurrence of the tumor [15,16].…”

Atypical fibroxanthoma

“…In its less common form, the tumor occurs on the limbs and trunk when there is a lack of association with sun exposure in young individuals (Dahl I, 1976). Interestingly, AFX develops in organ transplant recipients who may be in a state of immunosuppression (Hafner J et al 1999;Kanitakis J et al 1996;Paquet P and Pierard GE, 1996). There have been rare reports of cases of multiple tumors Nadjem MA et al 1988).…”