ISSN:
1569-8041
Keywords:
immunosuppression
;
seminoma
;
transplantation
Source:
Springer Online Journal Archives 1860-2000
Topics:
Medicine
Notes:
Abstract A 37-year-old man who had successfully undergone cardiac transplantationfor dilated cardiomyopathy presented with a history of severe pain over hisleft shoulder, rib cage and thoracic spine. Clinical examination revealed thepresence of bony tenderness over these sites, but there was no other clinicalevidence of malignancy. Further investigations suggested the presence ofmultiple bony metastases. Bone biopsy revealed extensive bone marrowinfiltration by large undifferentiated cells showing pronounced cytoplasmicvacuolation with a striking granulomatous reaction. Immunocytochemistryrevealed these anaplastic cells to be cytokeratin and placenta-like alkalinephosphatase positive but S100, CD30 and lymphoid marker negative. Analyses byin situhybridisation of these cells revealed no evidence ofEpstein–Barr virus infection. Overall the pathology suggested adiagnosis of metastatic seminoma. Confirmation of this diagnosis was obtainedby the analysis of serum human chorionic gonadotrophin which was elevated at90 IU/l. In the absence of testicular or retroperitoneal disease, it is very likelythat this unusual case of metastatic seminoma was related to the patient'simmunosuppressive therapy, which at diagnosis included cyclosporin andprednisolone. The patient was successfully treated with cisplatin basedchemotherapy and decreased immunosuppression and remains in complete remissionone year after completion of chemotherapy. Seminoma is an uncommon complication of prolonged immunosuppression withvery few cases being described in the literature post-organ transplantation.This case shows that the clinical presentation of this treatable tumour inthis patient population can be unusual and difficult to diagnose.
Type of Medium:
Electronic Resource
URL:
http://dx.doi.org/10.1023/A:1008351517626
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