BK Virus–Associated Urothelial Carcinoma of a Ureter Graft in a Renal Transplant Recipient: A Case Report

• Published in: Transplantation proceedings 2014-03, Vol.46 (2), p.616-619
• Main Authors: Oikawa, M, Hatakeyama, S, Fujita, T, Murakami, R, Hagiwara, K, Narita, T, Noro, D, Tanaka, T, Tanaka, Y, Tobisawa, Y, Yoneyama, Tohru, Yoneyama, Takahiro, Hashimoto, Y, Koie, T, Narumi, S, Ohyama, C
• Format: Article
• Language: English
• Subjects: BK Virus - pathogenicity; Humans; Kidney Transplantation - adverse effects; Male; Middle Aged; Surgery; Ureter - surgery; Urinary Bladder Neoplasms - etiology; Urinary Bladder Neoplasms - virology; Urography
• ISSN: 0041-1345; 1873-2623
• DOI: 10.1016/j.transproceed.2013.09.037

Abstract Background Urothelial carcinomas of ureter grafts in renal transplant patients are rare. Here we report our experience with a case of BK virus–associated urothelial carcinoma in a ureter graft. Case Report A 47-year-old man developed chronic renal failure secondary to diabetes mellitus and started maintenance hemodialysis in September 2007. Two months later, the patient received a renal transplant from his 70-year-old mother. The patient developed BK virus–associated nephropathy 1 year after transplantation and presented with a decline in renal function and hydronephrosis in the transplanted kidney 4 years 6 months after transplantation. Cystoscopy and retrograde pyelography revealed an irregular filling defect in the ureter graft. Cytologic diagnosis of his urine revealed a high-grade urothelial carcinoma. Computerized tomography showed a cT2 ureteral tumor and no involvement of other organs. The patient subsequently underwent a transplant nephroureterectomy with bladder cuff resection. Histopathologic findings revealed a high-grade urothelial carcinoma, pT2, in the ureter graft with SV40-positive staining. The patient was closely observed without adjuvant chemotherapy therapy and remained disease free 1 year after surgery. Renal transplant recipients with BK virus infection are at high risk of developing urologic malignancies. Close attention is necessary to diagnose post-transplantation urologica malignancies as early as possible.