We report the case of a 53-year-old female patient who was transplanted with the liver of a 71-year-old male donor for advanced
primary sclerosing cholangitis (PSC) and who additionally was diagnosed with a histologically non-classifiable
colitis shortly before
transplantation. Upon follow-up abdominal ultrasound 4 months after
transplantation, a liver lesion measuring 16 × 23 mm was detected in the transplanted liver. This lesion had not been noticed immediately after
transplantation and showed a pattern suspicious for
malignancy in contrast-enhanced ultrasound. In line, a biopsy revealed the presence of a
metastasis of an
adenocarcinoma of colorectal origin, suggesting that a
colitis- and PSC-associated
colorectal cancer of the recipient might have been overseen upon the initial diagnostic workup. Despite two negative follow-up colonoscopies, this hypothesis was further supported by a strong positive signal in projection to the cecum in a subsequently performed PET/CT-scan. However, surgical resection of the right colon that was performed simultaneously with the atypical resection of the liver
metastasis only revealed an inflamed
diverticulum but no
malignancy in the resected colon segment. Moreover, cytogenetic and molecular genetic testing on the resected specimens clearly attributed the
metastasis to the male donor. On the one hand, this case underlines the necessity of endoscopic surveillance of patients with PSC and/or
inflammatory bowel disease as well as the challenges in diagnosis of
colitis-associated cancer. On the other hand, it shows that the acceptance of organs from elderly donors in times of organ shortage might be linked to an increased risk of donor transmitted
malignancies.