Abstract: SA-PO1120
Metastatic Round Cell Sarcoma in a Renal Transplant Recipient
Session Information
- Transplant Trainee Case Reports
November 09, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Trainee Case Report
- 1902 Transplantation: Clinical
Authors
- Shettigar, Reshma, Dunedin Public Hospital, Dunedin, New Zealand
- Walker, Robert J., University of Otago, Dunedin, New Zealand
- Putt, Tracey L., Dunedin Hospital, Dunedin, New Zealand, Dunedin, New Zealand
Introduction
We present a rare case of metastatic round cell sarcoma in a renal transplant recepient. Our literature search shows this is a first reported case round cell sarcoma in this group of patients.
Case Description
57-year-old male, end stage renal failure due to polycystic kidneys, underwent deceased donor renal transplantation. Patient received standard induction immunosuppression with basiliximab and maintainence immunosuppression of mycophenolate, tacrolimus and prednisone. 6 months post transplant patient noticed a lump about 4 cm in diameter on the medial side of the lower end of his thigh. Ultrasound showed that this mass was arising from the Sartorius muscle. He further underwent a biopsy of this mass, which showed un-differentiated round cell sarcoma. Staging CT scan did not show any evidence of metastatic disease. It was decided patient would have radiation therapy followed by surgical removal of sarcoma. A week prior to surgery, he presented with severe back pain and epistaxis. Blood test revealed thrombocytopenia with platelet count of 9* 109/litre . CT scan showed several metastatic lesions in lumbar spine and femur and lungs. Patient was deemed to unwell to tolerate chemotherapy. We did discuss with patient regarding stopping or reducing immunosuppression at the time of diagnosis of metastatic disease, as this might slow the progression of disease, however patient refused this. Patient was managed with platelet transfusion and analgesia with a plan to offer radiation therapy for pain. Patient was referred to Hospice for management of symptoms and end of life care and passed away 2 weeks later.
Discussion
Sarcomas are heterogeneous group of aggressive malignant tumors of mesenchymal origin that make up less than 1% of adult malignancies. Unlike Kaposis sarcoma, which is associated with immunosuppression, round cell sarcoma has never been reported in renal transplant recipient. Role of immunosuppression contributing to the genesis and progression of this tumor is unknown. Despite treatment with aggressive chemotherapy and radiation therapy, prognosis with metastatic round cell sarcoma is extremely poor. In our patient, sarcoma on intially testing was limited disease and thought to be curable. However within 1 months time, it progressed from solitary lesion to multiorgan metastasis. We think Immunosuppression might have contributed to accelerated progression.