Transmission of glioblastoma multiforme through liver transplantation

The 47-year-old woman had a frontal lobe glioma removed. 4 months later, 1 week after resection of a local tumour recurrence, she deteriorated neurologically, and brain death was diagnosed. Informed consent of the legally responsible relatives was obtained, and her liver and both kidneys were harvested for transplantation. At necropsy, no other cancer or metastases were found. 5 months after transplantation, the 29-year-old immunosuppressed liver transplant recipient died after rapid clinical deterioration. Necropsy showed multiple intrahepatic, adrenal gland, lymph-node and leptomeningeal metastases of a gliomatous tumour. No coexisting malignant disease was found. Both kidney recipients are doing well without any signs of cancer at 52 months after transplantation. In cases of possible transmitted cancer, there must be certainty that the cancer came from the donor and was derived from the primary tumour. To our knowledge, this is the first case in which both criteria were fulfilled. Histopathological examination of the primary and recurrent brain tumour and of all metastatic lesions showed the classic features of glioblastoma multiforme. Immunoreactivity was negative for epithelial differentiation markers (KL-1, vimentin, desmin), for S-100P and for Blymphocyte marker L26. The primary glioblastoma was the only lesion to express glial fibrillary acidic protein (GFAP). Loss of GFAP expression during disease progression coincided with the less differentiated histological appearance of the locally recurrent and metastatic lesions and is directly associated with glioma dissemination. 2 All findings were