Clinicopathologic Characterization of Post–Renal Transplantation BK Polyomavirus-Associated Urothelial CarcinomaSingle Institutional Experience

• Published in: American journal of clinical pathology 2020-02, Vol.153 (3), p.303-314
• Main Authors: Chu, Ying-Hsia, Zhong, Weixiong, Rehrauer, William, Pavelec, Derek M, Ong, Irene M, Arjang, Djamali, Patel, Sanjay S, Hu, Rong
• Format: Article
• Language: English
• Subjects: Adult; Aged; BK Virus; Bladder cancer; Carcinoma, Renal Cell - etiology; Carcinoma, Renal Cell - pathology; Carcinoma, Transitional Cell - etiology; Carcinoma, Transitional Cell - pathology; Female; Genomes; Humans; Kidney - pathology; Kidney cancer; Kidney Neoplasms - etiology; Kidney Neoplasms - pathology; Kidney transplantation; Kidney Transplantation - adverse effects; Lymph nodes; Male; Middle Aged; p53 Protein; Polyomavirus Infections - etiology; Polyomavirus Infections - pathology; Postoperative Complications - etiology; Postoperative Complications - pathology; Renal cell carcinoma; Retrospective Studies; Transplants & implants; Tumor Virus Infections - etiology; Tumor Virus Infections - pathology; Urothelial carcinoma
• ISSN: 0002-9173; 1943-7722
• DOI: 10.1093/ajcp/aqz167

Abstract Objectives To review rare cases of BK polyomavirus (BKPyV) associated urologic carcinomas in kidney transplant recipients at one institution and in the literature. Methods We describe the clinicopathologic features of BKPyV-associated urologic carcinomas in a single-institution cohort. Results Among 4,772 kidney recipients during 1994 to 2014, 26 (0.5%) and 26 (0.5%) developed posttransplantation urothelial carcinomas (UCs) and renal cell carcinomas (RCCs), respectively, as of 2017. Six (27%) UCs but none of the RCCs expressed large T antigen (TAg). TAg-expressing UCs were high grade with p16 and p53 overexpression (P < .05 compared to TAg-negative UCs). Tumor genome sequencing revealed BKPyV integration and a lack of pathogenic mutations in 50 cancer-relevant genes. Compared to TAg-negative UCs, TAg-expressing UCs more frequently presented at advanced stages (50% T3-T4) with lymph node involvement (50%) and higher UC-specific mortality (50%). Conclusions Post-renal transplantation BKPyV-associated UCs are aggressive and genetically distinct from most non-BKPyV–related UCs.