Oncocytoma managed by active surveillance in a transplant allograft kidney: a case report

Abstract

BackgroundThe ethical implications of the utilization of kidneys with solid renal masses (SRMs) in transplantation are the subject of lively debate in the transplantation community and beyond. One of such implications is that as the life expectancy of renal transplant patients improve, the prevalence of SRMs in donors is likely to increase. We report a case of an oncocytoma in a renal allograft complicating a deceased-donor kidney transplant.Case presentationA 60-year-old woman received and underwent deceased-donor renal transplantation for end-stage renal disease after a waiting-list period of 11 years. Kidney Doppler ultrasound (DUS) of the deceased donor was negative for any nodular lesion. The finding of the DUS, done on postoperative day 1, to assess the patency of the graft, was suspicious for an acute arterial thrombosis but did not reveal any focal irregularities. An ensuing computed tomography (CT) scan did not show any arterial complications but serendipitously revealed a 2.4-cm lesion on the upper pole of the renal allograft, which was not detected during the back-table or ultrasonography monitoring. Histology of the biopsied lesion was consistent with oncocytoma. However, because the eosinophilic variant of chromophobe renal cell carcinoma may morphologically resemble renal oncocytoma, immunohistochemical staining was performed. The results were negative, ruling out chromophobe RCC. After discussing the therapeutic options and potential related outcomes with the patient, we found no reason for resection of the lesion or an allograft nephrectomy, given the low risk of malignant transformation in an oncocytoma. Active surveillance of the benign tumor was done with ultrasonography, every 2 months, for the first year and, then, with magnetic resonance imaging, every year. The patient received mycophenolate-mofetil, tacrolimus, and prednisone throughout the 5-year follow-up period, and the regimen for immunosuppression was not changed despite the presence of the renal mass. After 60 months, we report that none of the radiological findings have shown any morphological changes of the lesion, and the patient is well.ConclusionTo the best of our knowledge, we report the first case of an oncocytoma in a renal allograft complicating a deceased-donor kidney transplant, which was successfully managed by active surveillance.

Management of Renal Cell Carcinoma and Other Renal Masses in the Kidney Graft

“…There is no evidence for a risk of malignant transformation. A case report of biopsy-confirmed oncocytoma in a renal allograft demonstrated stable radiological appearances over 5 years with annual MRI surveillance [28].…”

A functional variant on 20q13.33 related to glioma risk alters enhancer activity and modulates expression of multiple genes

“…RTEL1-TNFRSF6B is a noncoding, readthrough transcript that is subject to NMD (Chang et al, 2007), but it is currently unclear how a change in mRNA decay will affect glioma development. SRMS belongs to a family of nonreceptor tyrosine kinases that have been involved in a number of cancers, including fibrosarcoma (Lin et al, 2013), eosinophilic variant of chromophobe renal cell carcinoma (Pagano et al, 2018), and breast cancer (Fan et al, 2015), but its function in gliomagenesis remains unknown. Additional studies will be required to determine if these genes are indeed relevant to glioma risk.…”