Transmission of donor-derived breast carcinoma as a recurrent mass in a keratolimbal allograft

Audra K. Miller, Jonathan W. Young, David Wilson, Jennifer Dunlap, Winston Chamberlain

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Purpose: To report a case of local transmission of invasive lobular carcinoma from a donor to a recipient in a keratolimbal allograft after cessation of systemic immunosuppressive therapy. Methods: This is a case report including the clinicopathologic findings. Sections of the donor breast tumor and recipient conjunctival lesions were stained with hematoxylin and eosin. Immunohistochemical studies were performed using pancytokeratin, CK7, CK20, CAM 5.2, CD138, TTF1, estrogen receptor, progesterone receptor, GATA-3, GCDFP-15, and mammaglobin. Polymerase chain reaction-based DNA profiling of tumor cells was performed. Results: Histopathologic examination revealed an infiltrate of atypical cells with large hyperchromatic nuclei consistent with carcinoma. Immunohistochemical analysis showed pancytokeratin, CK7, CAM 5.2, GATA-3, and estrogen receptor positivity and progesterone receptor absence, consistent with the previously determined phenotype of the donor's breast carcinoma. Results of polymerase chain reaction analysis were also consistent with the donor's tumor. After reduced dosing of tacrolimus and mycophenolate mofetil, 2 limbal tumors occurred in the recipient. The immunosuppressive treatment had been stopped completely before the appearance of the third lesion. The recipient had no history of malignancy, and she had routine screenings for breast cancer. Conclusions: We report a case of donor-derived breast carcinoma in a keratolimbal allograft recipient. The grafted tissue harbored donor-derived tumor cells for more than 4 years after surgery even after systemic immunosuppression was discontinued. Although no similar reports of tumor transfer could be found in the literature, this case suggests the need for increased stringency in donor selection and heightened surveillance for such tumor transmission.

Original languageEnglish (US)
Pages (from-to)736-739
Number of pages4
JournalCornea
Volume36
Issue number6
DOIs
StatePublished - 2017

Fingerprint

Allografts
Breast Neoplasms
Neoplasms
Progesterone Receptors
Immunosuppressive Agents
Estrogen Receptors
Mycophenolic Acid
Lobular Carcinoma
Donor Selection
Polymerase Chain Reaction
DNA Fingerprinting
Tacrolimus
Hematoxylin
Eosine Yellowish-(YS)
Immunosuppression
Tissue Donors
Carcinoma
Phenotype
Therapeutics

Keywords

  • Allogeneic limbal stem cells
  • Cancer transmission
  • Conjunctival neoplasm
  • Donor-transmitted carcinoma
  • Invasive lobular breast carcinoma
  • Keratolimbal allograft
  • KLAL procedure
  • Limbal stem cell disease
  • Limbal stem cell transplant
  • Metastatic carcinoma

ASJC Scopus subject areas

  • Ophthalmology

Cite this

Transmission of donor-derived breast carcinoma as a recurrent mass in a keratolimbal allograft. / Miller, Audra K.; Young, Jonathan W.; Wilson, David; Dunlap, Jennifer; Chamberlain, Winston.

In: Cornea, Vol. 36, No. 6, 2017, p. 736-739.

Research output: Contribution to journalArticle

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title = "Transmission of donor-derived breast carcinoma as a recurrent mass in a keratolimbal allograft",
abstract = "Purpose: To report a case of local transmission of invasive lobular carcinoma from a donor to a recipient in a keratolimbal allograft after cessation of systemic immunosuppressive therapy. Methods: This is a case report including the clinicopathologic findings. Sections of the donor breast tumor and recipient conjunctival lesions were stained with hematoxylin and eosin. Immunohistochemical studies were performed using pancytokeratin, CK7, CK20, CAM 5.2, CD138, TTF1, estrogen receptor, progesterone receptor, GATA-3, GCDFP-15, and mammaglobin. Polymerase chain reaction-based DNA profiling of tumor cells was performed. Results: Histopathologic examination revealed an infiltrate of atypical cells with large hyperchromatic nuclei consistent with carcinoma. Immunohistochemical analysis showed pancytokeratin, CK7, CAM 5.2, GATA-3, and estrogen receptor positivity and progesterone receptor absence, consistent with the previously determined phenotype of the donor's breast carcinoma. Results of polymerase chain reaction analysis were also consistent with the donor's tumor. After reduced dosing of tacrolimus and mycophenolate mofetil, 2 limbal tumors occurred in the recipient. The immunosuppressive treatment had been stopped completely before the appearance of the third lesion. The recipient had no history of malignancy, and she had routine screenings for breast cancer. Conclusions: We report a case of donor-derived breast carcinoma in a keratolimbal allograft recipient. The grafted tissue harbored donor-derived tumor cells for more than 4 years after surgery even after systemic immunosuppression was discontinued. Although no similar reports of tumor transfer could be found in the literature, this case suggests the need for increased stringency in donor selection and heightened surveillance for such tumor transmission.",
keywords = "Allogeneic limbal stem cells, Cancer transmission, Conjunctival neoplasm, Donor-transmitted carcinoma, Invasive lobular breast carcinoma, Keratolimbal allograft, KLAL procedure, Limbal stem cell disease, Limbal stem cell transplant, Metastatic carcinoma",
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AU - Miller, Audra K.

AU - Young, Jonathan W.

AU - Wilson, David

AU - Dunlap, Jennifer

AU - Chamberlain, Winston

PY - 2017

Y1 - 2017

N2 - Purpose: To report a case of local transmission of invasive lobular carcinoma from a donor to a recipient in a keratolimbal allograft after cessation of systemic immunosuppressive therapy. Methods: This is a case report including the clinicopathologic findings. Sections of the donor breast tumor and recipient conjunctival lesions were stained with hematoxylin and eosin. Immunohistochemical studies were performed using pancytokeratin, CK7, CK20, CAM 5.2, CD138, TTF1, estrogen receptor, progesterone receptor, GATA-3, GCDFP-15, and mammaglobin. Polymerase chain reaction-based DNA profiling of tumor cells was performed. Results: Histopathologic examination revealed an infiltrate of atypical cells with large hyperchromatic nuclei consistent with carcinoma. Immunohistochemical analysis showed pancytokeratin, CK7, CAM 5.2, GATA-3, and estrogen receptor positivity and progesterone receptor absence, consistent with the previously determined phenotype of the donor's breast carcinoma. Results of polymerase chain reaction analysis were also consistent with the donor's tumor. After reduced dosing of tacrolimus and mycophenolate mofetil, 2 limbal tumors occurred in the recipient. The immunosuppressive treatment had been stopped completely before the appearance of the third lesion. The recipient had no history of malignancy, and she had routine screenings for breast cancer. Conclusions: We report a case of donor-derived breast carcinoma in a keratolimbal allograft recipient. The grafted tissue harbored donor-derived tumor cells for more than 4 years after surgery even after systemic immunosuppression was discontinued. Although no similar reports of tumor transfer could be found in the literature, this case suggests the need for increased stringency in donor selection and heightened surveillance for such tumor transmission.

AB - Purpose: To report a case of local transmission of invasive lobular carcinoma from a donor to a recipient in a keratolimbal allograft after cessation of systemic immunosuppressive therapy. Methods: This is a case report including the clinicopathologic findings. Sections of the donor breast tumor and recipient conjunctival lesions were stained with hematoxylin and eosin. Immunohistochemical studies were performed using pancytokeratin, CK7, CK20, CAM 5.2, CD138, TTF1, estrogen receptor, progesterone receptor, GATA-3, GCDFP-15, and mammaglobin. Polymerase chain reaction-based DNA profiling of tumor cells was performed. Results: Histopathologic examination revealed an infiltrate of atypical cells with large hyperchromatic nuclei consistent with carcinoma. Immunohistochemical analysis showed pancytokeratin, CK7, CAM 5.2, GATA-3, and estrogen receptor positivity and progesterone receptor absence, consistent with the previously determined phenotype of the donor's breast carcinoma. Results of polymerase chain reaction analysis were also consistent with the donor's tumor. After reduced dosing of tacrolimus and mycophenolate mofetil, 2 limbal tumors occurred in the recipient. The immunosuppressive treatment had been stopped completely before the appearance of the third lesion. The recipient had no history of malignancy, and she had routine screenings for breast cancer. Conclusions: We report a case of donor-derived breast carcinoma in a keratolimbal allograft recipient. The grafted tissue harbored donor-derived tumor cells for more than 4 years after surgery even after systemic immunosuppression was discontinued. Although no similar reports of tumor transfer could be found in the literature, this case suggests the need for increased stringency in donor selection and heightened surveillance for such tumor transmission.

KW - Allogeneic limbal stem cells

KW - Cancer transmission

KW - Conjunctival neoplasm

KW - Donor-transmitted carcinoma

KW - Invasive lobular breast carcinoma

KW - Keratolimbal allograft

KW - KLAL procedure

KW - Limbal stem cell disease

KW - Limbal stem cell transplant

KW - Metastatic carcinoma

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