[1928] Neoplasms in Lung Explants: A Retrospective Review of 311 Consecutive Orthotopic Lung Transplants

Justin Poling, Peter B Illei. Johns Hopkins Medical Institutions, Baltimore, MD

Background: There are only few case reports of neoplasms in explanted lungs and only one case series describing multiple incidences. Many of the same risk factors for the development of non-neoplastic lung diseases, most notably tobacco exposure, are also risk factors for the development of lung carcinomas. Clinically undetected neoplasms discovered in the explanted lung(s) may necessitate treatment following transplantation that may affect both short- and long-term survival.
Design: We reviewed the surgical pathology reports of 311 consecutive lung explants performed at our institution. Routine workup included serial sectioning (at 0.5-1.0 cm) with careful palpation of the entire lung parenchyma and histologic analysis of multiple sections from all lobes, the bronchial margin and hilar lymph nodes. For patients with tumors we reviewed the clinical records including follow-up treatment and survival data, pre-transplant imaging studies, and tobacco history.
Results: Seven of 311 (2.2%) lung explants had neoplasms. Common reasons for OLT included COPD (31%), UIP/IPF (22.5%), cystic fibrosis (18%), sarcoidosis (5.1%) and scleroderma (4.2%). Tumors were seen in COPD (x2), UIP/IPF (x2), sarcoidosis (x2) and cystic fibrosis. Summary of tumor types and clinical data are shown in table 1. Of the patients with tobacco status documented, 4/4 (100%) had a significant smoking history. On pre-operative imaging several patients abnormal findings, but these were attributed to the underlying non-neoplastic processes.

Table 1.
Reason for OLTAge/SexTumor typeTherapyFollow up
COPD49 FSQCA 1.5 cmNoneDay 454 Died of DAD, NED
COPD57 FSCLC 0.4 cm & SqCIS @ marginCisplatin-Etoposide & RTDay 458 NED
UIP/IPF54MACA bilateralNoneDay 45 DOD
UIP/IPF62Typical carcinoid (0.2 cm)NoneDay 20 NED
Sarcoidosis61 MGarnular cell tumor (0.7 cm)NoneDay 693 NED
Sarcoidosis48 MMALT lymphoma, bilateralNoneDay 628 NED
Cystic fibrosis59 FCatleman DiseaseNoneDay 927 NED

Conclusions: Although not common, clinically undetected neoplasms are present in explanted lungs. The majority of these neoplasms are early stage and do not require additional therapy. Similar to the general population strong smoking history increases the risk of tumors in OLT. Explanted lungs should be carefully examined grossly and microscopically because of the small size of these tumors. Routine sections should include the bronchial margins and hilar lymph nodes.
Category: Pulmonary

Tuesday, March 5, 2013 1:45 PM

Proffered Papers: Section D, Tuesday Afternoon


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