Diane C. Strollo MD, Presenter: Nothing to Disclose

Iclal Ocak MD, Abstract Co-Author: Nothing to Disclose

Sonja Dacic MD, Abstract Co-Author: Nothing to Disclose

Yoshya Toyoda MD, Abstract Co-Author: Nothing to Disclose

Christian Bermudez, Abstract Co-Author: Nothing to Disclose

Kenneth McCurry MD, Abstract Co-Author: Nothing to Disclose

Bruce Johnson, Abstract Co-Author: Nothing to Disclose

Joseph M Pilewski MD, Abstract Co-Author: Nothing to Disclose

Maria Crespo MD, Abstract Co-Author: Nothing to Disclose

00030490-DMT et al, Abstract Co-Author: Nothing to Disclose

Assess CT and pathologic features of cancer incidentally detected at lung transplantation  

We retrospectively reviewed our lung transplant registry from 2004 to 2009 for incidental malignancy detected at transplantation. Pre-transplant chest CTs were reviewed by 2 thoracic radiologists.  Histopathology was confirmed by a pulmonary pathologist.  We reviewed CTs for diffuse lung disease and for solitary or multiple pulmonary nodules, masses, consolidation, ground glass opacity, pleural effusion and/or lymphadenopathy. Lesion size, morphology and location were correlated with histopathology and surgical and pathology reports. Intervals between CTs and time of transplantation were recorded. Cancers were pathologically staged.

Of 503 lung transplant recipients, 13 had cancer incidentally detected at transplantation. Patients received double (n=10) vs. single lung transplants (n=2), and 1 surgery was aborted due to unresectable malignancy. Patients had emphysema (n=8), fibrosis (n=5) and obliterative bronchiolitis (n=1). Mean age was 56.4 years. Histopathology revealed 9 solitary non-small cell lung carcinomas (NSCLC) and 1 each of multi-focal NSCLC, sarcoma, metastatic thyroid cancer, and lymphoproliferative disease (PTLD) in a re-transplant patient.  Intervals between CT and surgery were 0 days to 17 months (mean 3.5 months). 5 cases had no CT findings of cancer while 8 cases had 3 solitary lung nodules and 1 each of multifocal masses, ground glass opacity, hilar mass with lobar obstruction, mediastinal adenopathy (>2 cm), and  multifocal consolidation, mediastinal adenopathy and pleural effusion. 6 of these cases also had new or resolving nodules with benign pathology in explanted lung(s). On pathology, occult neoplasms (n=5) measured 2-17 mm (mean 6mm), including NSCLC (n=4) and metastatic thyroid cancer (n=1). Cancer detected on CT (n=8) measured 5 - 50 mm (mean 29 mm), including 6 NSCLC, 1 sarcoma and 1 PTLD. Pathologic cancer stages were 1 or 2 (n=9) or 3B or 4 (n=4). 4 of 5 occult cancers on CT were Stage 1 or 2 NSCLC. 

Incidental cancer detected at lung transplantation is typically stage 1 or 2 NSCLC and may be occult or indeterminate on CT. Diffuse lung disease and multiple abnormalities may limit the CT diagnosis of cancer. 

Cancer detected at lung transplantation is unusual, may be difficult to predict on CT and may compromise clinical outcomes.

Strollo, D, Ocak, I, Dacic, S, Toyoda, Y, Bermudez, C, McCurry, K, Johnson, B, Pilewski, J, Crespo, M, et al, 0, Radiologic-Pathologic Features of Incidental Cancer Detected at Lung Transplantation.  Radiological Society of North America 2009 Scientific Assembly and Annual Meeting, November 29 - December 4, 2009 ,Chicago IL. http://archive.rsna.org/2009/8006935.html