Oral carcinoma development after 23 years of renal transplantation

Isabel Schausltz Pereira Faustino; Diego Teztner Fernandes; Alan Roger Santos-Silva; Pablo Agustin Vargas; Marcio Ajudarte Lopes

doi:10.4322/acr.2019.112

Abstract

Renal transplant patients are treated with immunosuppressive drugs that decrease the effectiveness of the immune system, making them more prone to developing cancer. Skin and lip carcinomas are common malignancies encountered after transplantation, whereas oral carcinomas are rare. We report the case of a 51-year-old female Caucasian patient, with no history of smoking, who presented white lesions on the tongue and an ulcerated lesion on the lower lip beginning 4 months prior. Diagnosis of squamous cell carcinoma for both lesions was made following incisional biopsies. Interestingly, the patient reported a renal transplantation 23 years prior, and was maintained on a combination of cyclosporine, mycophenolate sodium and prednisone. The patient also presented a history of several basal and squamous cell carcinomas on sun-exposed areas of the skin. Both lesions were surgically excised. No sign of recurrence or new lesions in the oral cavity have been observed; however, new skin lesions are frequently diagnosed. This case report highlights that oral cancers may occur in transplant patients in the absence of classical risk factors. Thus, clinicians must be aware of the importance of thorough oral examination in transplant patients in routine follow-up.

Keywords

Lip neoplasm, Tongue neoplasm, Mouth neoplasm, Kidney transplantation

References

Wolfe RA, Ashby VB, Milford EF, et al. Comparison of mortality in all patients on dialysis, patients on dialysis awaiting transplantation, and recipients of a first cadaveric transplant.

N Engl J Med. 1999;341(23):1725-30. [https://doi.org/10.1056/NEJM199912023412303]. [PMID:10580071]

Laupacis A, Keown P, Pus N, et al. A study of the quality of life and cost utility of renal transplantation.

Kidney Int. 1996;50(1):235-42. [https://doi.org/10.1038/ki.1996.307]. [PMID:8807593]

Vajdic CM, McDonald SP, McCredie MR, et al. Cancer incidence before and after kidney transplantation.

JAMA. 2006;296(23):2823-31. [https://doi.org/10.1001/jama.296.23.2823]. [PMID:17179459]

Penn I. Tumors after renal and cardiac transplantation.

Hematol Oncol Clin North Am. 1993;7(2):431-45. [https://doi.org/10.1016/S0889-8588(18)30250-8]. [PMID:8468275]

Ho M. Risk factors and pathogenesis of posttransplant lymphoproliferative disorders.

Transplant Proc. 1995;27(5, Suppl 1):38-40. [PMID:7482816]

Levy JA. A new human herpesvirus: KSHV or HHV8?

Lancet. 1995;346(8978):786. [https://doi.org/10.1016/S0140-6736(95)91611-3]. [PMID:7674737]

Pendón-Ruiz de Mier V, Navarro Cabello MD, Martínez Vaquera S, et al. Incidence and long-term prognosis of cancer after kidney transplantation.

Transplant Proc. 2015;47(9):2618-21. [https://doi.org/10.1016/j.transproceed.2015.08.043]. [PMID:26680052]

Penn I. Depressed immunity and the development of cancer.

Cancer Detect Prev. 1994;18(4):241-52. [PMID:7982234]

Laprise C, Cahoon EK, Lynch CF, et al. Risk of lip cancer after solid organ transplantation in the United States.

Am J Transplant. 2019;19(1):227-37. [https://doi.org/10.1111/ajt.15052]. [PMID:30074684]

Lee YW, Gisser SD. Squamous cell carcinoma of the tongue in a nine year renal transplant survivor: a case report with a discussion of the risk of development of epithelial carcinomas in renal transplant survivors.

Cancer. 1978;41(1):1-6. [https://doi.org/10.1002/1097-0142(197801)41:1<1::AID-CNCR2820410101>3.0.CO;2-1]. [PMID:342080]

Meng S, Jiamei L. Management of tongue cancer in the patient who is systemically immunosuppressed: a preliminary report.

Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2000;90(6):689-93. [https://doi.org/10.1067/moe.2000.111411]. [PMID:11113812]

Zhang L, Epstein JB, Poh CF, et al. Comparison of HPV infection, p53 mutation and allelic losses in post-transplant and non-posttransplant oral squamous cell carcinomas.

J Oral Pathol Med. 2002;31(3):134-41. [https://doi.org/10.1034/j.1600-0714.2002.310302.x]. [PMID:11903818]

Malleshappa P, Aghariya M, Tampi C, Shah BV. Squamous cell carcinoma of tongue in a renal transplant recipient.

Indian J Med Paediatr Oncol. 2009;30(4):136-7. [https://doi.org/10.4103/0971-5851.65336]. [PMID:20838555]

Prakash J, Prabhakar H, Kumar M, Aralapuram K. Carcinoma of the tongue in a renal transplant recipient: a rare post-transplant malignancy.

Saudi J Kidney Dis Transpl. 2015;26(1):103-6. [https://doi.org/10.4103/1319-2442.148753]. [PMID:25579725]

Andrés A. Cancer incidence after immunosuppressive treatment following kidney transplantation.

Crit Rev Oncol Hematol. 2005;56(1):71-85. [https://doi.org/10.1016/j.critrevonc.2004.11.010]. [PMID:15978827]

Villeneuve PJ, Schaubel DE, Fenton SS, Shepherd FA, Jiang Y, Mao Y. Cancer incidence among Canadian kidney transplant recipients.

Am J Transplant. 2007;7(4):941-8. [https://doi.org/10.1111/j.1600-6143.2007.01736.x]. [PMID:17331115]

Webster AC, Craig JC, Simpson JM, Jones MP, Chapman JR. Identifying high risk groups and quantifying absolute risk of cancer after kidney transplantation: a cohort study of 15183 recipients.

Am J Transplant. 2007;7(9):2140-51. [https://doi.org/10.1111/j.1600-6143.2007.01908.x]. [PMID:17640312]

van Leeuwen MT, Grulich AE, McDonald SP, et al. Immunosuppression and other risk factors for lip cancer after kidney transplantation.

Cancer Epidemiol Biomarkers Prev. 2009;18(2):561-9. [https://doi.org/10.1158/1055-9965.EPI-08-0919]. [PMID:19190169]

Yarosh DB, Pena AV, Nay SL, Canning MT, Brown DA. Calcineurin inhibitors decrease DNA repair and apoptosis in human keratinocytes following ultraviolet B irradiation.

J Invest Dermatol. 2005;125(5):1020-5. [https://doi.org/10.1111/j.0022-202X.2005.23858.x]. [PMID:16297204]

Canning MT, Nay S, Peña A, Yarosh DB. Calcineurin inhibitors reduce nuclear localization of transcription factor NFAT in UVirradiated keratinocytes and reduce DNA repair.

J Mol Histol. 2006;37(5-7):285-91. [https://doi.org/10.1007/s10735-006-9034-9]. [PMID:16927198]

Demir T, Ozel L, Gökçe AM, et al. Cancer screening of renal transplant patients undergoing long-term immunosuppressive therapy.

Transplant Proc. 2015;47(5):1413-7. [https://doi.org/10.1016/j.transproceed.2015.04.073]. [PMID:26093731]

Guba M, Graeb C, Jauch KW, Geissler EK. Pro- and anti-cancer effects of immunosuppressive agents used in organ transplantation.

Transplantation. 2004;77(12):1777-82. [https://doi.org/10.1097/01.TP.0000120181.89206.54]. [PMID:15223891]

Hibberd AD, Trevillian PR, Wlodarczyk JH, et al. Effect of immunosuppression for primary renal disease on the risk of cancer in subsequent renal transplantation: a population-based retrospective cohort study.

Transplantation. 2013;95(1):122-7. [https://doi.org/10.1097/TP.0b013e3182782f59]. [PMID:23238532]

van Leeuwen MT, Webster AC, McCredie MRE, et al. Effect of reduced immunosuppression after kidney transplant failure on risk of cancer: population based retrospective cohort study.

BMJ. 2010;340:c570. [https://doi.org/10.1136/bmj.c570]. [PMID:20150194]

López-Pintor RM, Hernández G, Arriba L, Andrés A. Lip cancer in renal transplant patients.

Oral Oncol. 2011;47(1):68-71. [https://doi.org/10.1016/j.oraloncology.2010.10.017]. [PMID:21112239]

Unsworth JD, Baldwin A, Byrd L. Systemic lupus erythematosus, pregnancy and carcinoma of the tongue.

BMJ Case Rep. 2013;31:2013. [https://doi.org/10.1136/bcr-2013-008864]. [PMID:23729701]

Song L, Wang Y, Zhang J, Song N, Xu X, Lu Y. The risks of cancer development in systemic lupus erythematosus (SLE) patients: a systematic review and meta-analysis.

Arthritis Res Ther. 2018;20(1):270. [https://doi.org/10.1186/s13075-018-1760-3]. [PMID:30522515]

Wong G, Chapman JR. Cancers after renal transplantation.

Transplant Rev (Orlando). 2008;22(2):141-9. [https://doi.org/10.1016/j.trre.2007.12.004]. [PMID:18631867]

Joshi K, Vivekanand J. Malignancies following kidney transplantation.

JNRT. 2009;2(1):94-105.

van Zuuren EJ, Visscher JG, Bavinck JNB. Carcinoma of the lip in kidney transplant recipients.

J Am Acad Dermatol. 1998;38(3):497-9. [https://doi.org/10.1016/S0190-9622(98)70516-X]. [PMID:9520038]

Jadotte YT, Schwartz RA. Solar cheilosis: an ominous precursor: part I. Diagnostic insights.

J Am Acad Dermatol. 2012;66(2):173-86. [https://doi.org/10.1016/j.jaad.2011.09.040]. [PMID:22243721]

Nico MMS, Rivitti EA, Lourenco SV. Actinic cheilitis: histologic study of the entire vermilion and comparison with previous biopsy.

J Cutan Pathol. 2007;34(4):309-14. [https://doi.org/10.1111/j.1600-0560.2006.00606.x]. [PMID:17381801]

Kumar M, Nanavati R, Modi TG, Dobariya C. Oral cancer: etiology and risk factors – a review.

J Cancer Res Ther. 2016;12(2):458-63. [https://doi.org/10.4103/0973-1482.186696]. [PMID:27461593]

Gueiros LA, Coletta RD, Kowalski LP, Lopes MA. Clinicopathological features and proliferation markers in tongue squamous cell carcinomas.

Int J Oral Maxillofac Surg. 2011;40(5):510-5. [https://doi.org/10.1016/j.ijom.2010.12.008]. [PMID:21277167]

Oral carcinoma development after 23 years of renal transplantation

Isabel Schausltz Pereira Faustino; Diego Teztner Fernandes; Alan Roger Santos-Silva; Pablo Agustin Vargas; Marcio Ajudarte Lopes

Abstract

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References

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Autops Case Rep

Oral carcinoma development after 23 years of renal transplantation

Isabel Schausltz Pereira Faustino; Diego Teztner Fernandes; Alan Roger Santos-Silva; Pablo Agustin Vargas; Marcio Ajudarte Lopes

Abstract

Keywords

References

Links

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Autops Case Rep