Mackenzie K A, Simcock J W, Lainchbury J G, Currie M J, Lynn K L
Angiogenesis and Cancer Research Group, Department of Pathology, University of Otago, Christchurch School of Medicine, PO Box 4345, Christchurch 8140, New Zealand.
Transplant Proc. 2009 Dec;41(10):4414-5. doi: 10.1016/j.transproceed.2009.09.056.
Myocardial metastasis from a cutaneous squamous cell carcinoma (SCC) is rare. Herein we have presented a case of metastasis from cutaneous SCC to the myocardium in a renal transplant recipient, which was confirmed by a cardiac fine-needle biopsy. Postmortem examination revealed disseminated metastatic disease involving myocardium, lungs, thyroid, skin, and peritoneum secondary to cutaneous SCC likely related to immunosuppression. At 46 years of age, he received a renal transplant for chronic renal failure caused by chronic glomerulonephritis. He started to develop multiple nonmelanoma skin cancers 4 years later. At least 23 invasive SCCs and 14 basal cell carcinomas were excised. His immunosuppressive regimen consisted of cyclosporine (150 mg), azathioprine (75 mg), and prednisone (10 mg daily), which was not modified despite multiple nonmelanoma skin cancers. Our case report further illustrates the potentially aggressive and fatal nature of cutaneous SCCs that can develop in organ transplant recipients. It argues for modification of the immunosuppressive regimen in such patients. The management of renal transplant patients with nonmelanoma skin cancers remains difficult and complex.
皮肤鳞状细胞癌（SCC）发生心肌转移较为罕见。在此，我们报告了一例肾移植受者皮肤SCC转移至心肌的病例，该病例经心脏细针活检得以确诊。尸检显示，继发于皮肤SCC的播散性转移性疾病累及心肌、肺、甲状腺、皮肤和腹膜，这可能与免疫抑制有关。46岁时，他因慢性肾小球肾炎导致的慢性肾衰竭接受了肾移植。4年后，他开始出现多发性非黑色素瘤皮肤癌。至少切除了23例浸润性SCC和14例基底细胞癌。他的免疫抑制方案包括环孢素（150毫克）、硫唑嘌呤（75毫克）和泼尼松（每日10毫克），尽管出现了多发性非黑色素瘤皮肤癌，但该方案并未调整。我们的病例报告进一步说明了器官移植受者可能发生的具有潜在侵袭性和致命性的皮肤SCC。这表明此类患者的免疫抑制方案需要调整。肾移植患者合并非黑色素瘤皮肤癌的管理仍然困难且复杂。
