Ruwanpathirana Anushka S, Fernando Samantha J, Vinati Molligoda M, Fernando Jay G, Zhang Wayne W, Premaratne Shyamal
Ohio State University, Columbus, OH, United States.
University of North Carolina, Wilmington, NC, United States.
Int J Surg Case Rep. 2021 Feb;79:275-280. doi: 10.1016/j.ijscr.2021.01.031. Epub 2021 Jan 15.
Solid organ transplantation has evolved along with dramatic advancements in definitive treatment for irreversible and uncompensated organ failure. Transplanted organ survival has improved as a result of reduced allograft rejection. However, negative long-term outcomes which were largely due to the adverse effects of rapidly evolving immunosuppressive regimens are still evident. The emergence of malignancies following prolonged exposure to immunosuppression treatment has affected the quality of life in transplant recipients. They are approximately one hundred times more likely to develop squamous cell carcinoma (SCC) compared to the general population and the incidence of malignant melanomas, basal cell carcinomas, and Kaposi's sarcomas are also on the rise. The incidence of de novo malignancies ranges from 9 to 21% and is commonly seen in the skin and the lymphoreticular system in these patients.
A 78-year-old male presented with a lump in the right axilla, which had grown in size over a 4-week period. Patient had received a cardiac transplant 9 years prior and was on a regimen of Tacrolimus and Mycophenolate Mofetil since then.
Following 4 years of immunosuppression therapy, the patient developed a non-healing ulcer on his right forearm and the biopsy confirmed SCC. The recent biopsy performed on the new axillary lump also confirmed SCC. Iatrogenic immune suppressive treatment is associated with the occurrence of de novo, non-melanoma skin cancers in the solid organ transplant recipients and this necessitates early and comprehensive cancer surveillance models to be included in the pre and post-transplant assessment.
Advances in immunology suggest that peripheral blood mononuclear cell sequencing and immune profiling to identify immune phenotypes associated with keratinocyte cancers allow us to recognize patients who are more susceptible for SCC following organ transplantation and immunosuppression.
随着不可逆和失代偿性器官衰竭的确定性治疗取得巨大进展，实体器官移植也不断发展。由于同种异体移植排斥反应的减少，移植器官的存活率有所提高。然而，主要由于快速发展的免疫抑制方案的不良反应导致的负面长期结果仍然很明显。长期接受免疫抑制治疗后恶性肿瘤的出现影响了移植受者的生活质量。与普通人群相比，他们患鳞状细胞癌（SCC）的可能性大约高一百倍，恶性黑色素瘤、基底细胞癌和卡波西肉瘤的发病率也在上升。新发恶性肿瘤的发病率在9%至21%之间，在这些患者中常见于皮肤和淋巴网状系统。
一名78岁男性因右腋窝出现肿块就诊，该肿块在4周内逐渐增大。患者9年前接受了心脏移植，此后一直服用他克莫司和霉酚酸酯。
免疫抑制治疗4年后，患者右前臂出现一个不愈合的溃疡，活检证实为SCC。最近对新出现的腋窝肿块进行的活检也证实为SCC。医源性免疫抑制治疗与实体器官移植受者新发非黑色素瘤皮肤癌的发生有关，这就需要在移植前和移植后的评估中纳入早期和全面的癌症监测模型。
免疫学的进展表明，通过外周血单个核细胞测序和免疫分析来识别与角质形成细胞癌相关的免疫表型，使我们能够识别出器官移植和免疫抑制后更容易患SCC的患者。
