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.
|Reason for OLT||Age/Sex||Tumor type||Therapy||Follow up|
|COPD||49 F||SQCA 1.5 cm||None||Day 454 Died of DAD, NED|
|COPD||57 F||SCLC 0.4 cm & SqCIS @ margin||Cisplatin-Etoposide & RT||Day 458 NED|
|UIP/IPF||54M||ACA bilateral||None||Day 45 DOD|
|UIP/IPF||62||Typical carcinoid (0.2 cm)||None||Day 20 NED|
|Sarcoidosis||61 M||Garnular cell tumor (0.7 cm)||None||Day 693 NED|
|Sarcoidosis||48 M||MALT lymphoma, bilateral||None||Day 628 NED|
|Cystic fibrosis||59 F||Catleman Disease||None||Day 927 NED|