Article

Collecting duct carcinoma arising in association with BK nephropathy post-transplantation in a pediatric patient. A case report with immunohistochemical and in situ hybridization study.

Department of Pathology, University of Utah School of Medicine and Associated Regional and University Pathologists (ARUP) Laboratories, Salt Lake City, UT, USA.
Pediatric Transplantation (Impact Factor: 1.63). 08/2008; 12(5):600-5. DOI: 10.1111/j.1399-3046.2007.00855.x
Source: PubMed

ABSTRACT The development of malignancy in a renal transplant graft is an uncommon phenomenon. A renal neoplasm developing in the adult donor kidney of a pediatric transplant recipient has only rarely been reported. We report a case of collecting duct carcinoma arising in association with BK virus nephropathy in an adult living-related donor renal allograft to a pediatric recipient. Our case is the second report of neoplasia occurring in association with BK virus nephropathy post-transplantation, suggesting that BK virus may play a role in oncogenesis. It has been proposed that the T-Ag protein encoded by the polyomavirus family of viruses disrupts chromosomal integrity, creating oncogenes, and inactivating tumor suppressor genes. In our study, immunohistochemical staining with antibody directed against BK virus large T antigen showed nuclear staining within urothelium, tubular epithelium, tubular intraepithelial neoplasia, and invasive carcinoma. In situ hybridization did not identify BK virus DNA within neoplastic cells. T-Ag protein expression has been shown to be tumor-specific in bladder, gastric, and colorectal cancers. The finding of T-Ag protein expression in both intraepithelial and invasive neoplastic tissues in our case raises the possibility of BK virus as a causative agent in oncogenesis.

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    • "The high seroprevalence and high detection rate of BKV and JCV by sensitive molecular tools in healthy individuals complicates studies and require a rigorous re-evaluation of the published data. For BKV, the most convincing data of an oncogenic contribution have been presented in single case reports of urothelial malignancies and renal tubular malignancies, typically in the setting of kidney transplantation as illustrated by three reported single cases: (Emerson et al., 2008; Geetha et al., 2002; Narayanan et al., 2007). In other reports, BKV is not found convincingly in such tumors (Kausman et al., 2004; Loghavi and Bose, 2011). "
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