Case Study#1   1  2  3  4  5  6  7  8  9  10  11  12  13  14  15  16  17  18  19   TUMORS AFTER RENAL TRANSPLANTATION Overall incidence of cancer: 6% (4-18%) Incidence of tumors increases dramatically with time after transplantation The most frequent encountered tumors: skin SCCs, NHLs, KSs, in situ carcinomas of the uterine cervix, carcinomas of the vulva and perineum, hepatobiliary carcinomas, sarcomas The percentage of lymphomas (PTLD) within malignant tumors is 16-22% vs 5% in general population. Among patients given OKT3 lymphomas comprise the 54% of all tumors. Incidence increases parallel to the intensity of immunosuppressive therapy. The incidence of PTLD is higher in heart than renal transplants Lymphomas appear at an average of 32 months (1-254) Among lymphomas: Hodgkin's disease: 2.5% NHLs: 93% vs 65% in general population Myelomas: 4% Incidence of NHLs is increased 29-40 fold over that seen in age-matched controls Among NHLs: 88% are of B-cell origin: frequently immunoblastic or large cell 12% are of T-cell origin 51% :multiple organ involvement 49%: single organ involvement 70% showed extranodal site involvement vs 24-48% in general population NHLs are thought to be EBV-induced, impairment of surveillance mechanisms, chronic antigenic stimulation by the allograft, viral oncogenesis, direct action of immunosuppresants 2 types of lymphomas: early onset: within the 1st year children or young adults (23 y) presentation with IMNL syndrome cyclosporine response to conservative treatment late onset: older age (48 years) localized mass poor outcome