Sepulveda Jaime L, Cioci Alessia C, Lew John I
DeWitt Daughtry Family Department of Surgery, University of Miami Leonard M. Miller School of Medicine, 1600 NW 10th Avenue, Miami, FL 33136, United States.
J Surg Case Rep. 2025 Aug 26;2025(8):rjaf655. doi: 10.1093/jscr/rjaf655. eCollection 2025 Aug.
Transplant eligibility in patients with suspected or untreated malignancy presents a complex clinical dilemma. Transplant guidelines historically recommend a cancer-free interval of 2-to-5 years prior to solid organ transplantation to reduce the risk of recurrence under immunosuppression. However, these timelines are not always feasible. We present the case of a woman with end-stage lung disease found to have a thyroid nodule with intermediate-high risk of malignancy. Due to her severe respiratory illness, she was deemed unlikely to meet the recommended cancer-free interval. After multidisciplinary evaluation, the patient underwent bilateral lung transplantation prior to thyroidectomy. Concern for tumor progression under immunosuppression led to total thyroidectomy in the immediate postoperative period. This case highlights the need for flexible transplant evaluation pathways and presents a rare instance of non-emergent oncologic surgery performed in the immediate post-transplant period. This work contributes to a growing body of literature advocating for nuance in transplant oncology decision-making.
疑似患有恶性肿瘤或未接受治疗的患者的移植资格存在复杂的临床困境。历史上，移植指南建议在实体器官移植前有2至5年的无癌间隔期，以降低免疫抑制下复发的风险。然而，这些时间线并不总是可行的。我们介绍了一名患有终末期肺病的女性病例，该患者被发现有一个具有中高恶性风险的甲状腺结节。由于她严重的呼吸系统疾病，她被认为不太可能达到推荐的无癌间隔期。经过多学科评估，患者在甲状腺切除术前接受了双侧肺移植。对免疫抑制下肿瘤进展的担忧导致在术后即刻进行了全甲状腺切除术。该病例凸显了灵活的移植评估途径的必要性，并呈现了移植后即刻进行非紧急肿瘤手术的罕见案例。这项工作为倡导移植肿瘤学决策细微差别的不断增长的文献做出了贡献。
