Metachronous Pulmonary Neoplasms in Lung Transplantation—When They Arise in the Donor Lung: A Case Report

Abstract Lung cancer (LC) is uncommon among lung transplanted patients, being most often described in the native lung of single-lung transplant recipients. Its appearance in the transplanted lung is a very uncommon phenomenon, in which donor and recipient factors appear to be involved. The authors present a case of two distinct metachronous lung neoplasms diagnosed in the transplanted lung of a non-smoker patient with Progressive Massive Silicosis (PMS), who underwent left unipulmonary transplantation at 39 years. The donor was a smoker and thoracic computed tomography (CT) performed before the organ collection showed no abnormalities.Thirty months after transplantation, a new node with significant avidity in Positron Emission Tomography (PET)-CT was diagnosed in the upper left lobe (ULL). The Thoracic Surgery team chose to proceed directly to surgery with atypical resection of the nodule. Anatomopathological study revealed an epidermoid carcinoma (pT1aNx).Multidisciplinary group decided clinical surveillance, however, two years later, the appearance of two new nodules in the ULL (PET-CT positive) was observed. It was again decided to proceed to the surgery with a second atypical resection. The anatomopathological study of one nodule revealed pulmonary adenocarcinoma (pT1aNx) and the other was compatible with epidermoid carcinoma (pT1aNx). One month later, the patient was hospitalized with a pulmonary abscess and posteriorly developed a probable acute allograft rejection, eventually dying at the age of 44, 51 months after transplantation. This case raises relevant questions regarding the donor selection criteria and the approach to lung cancer diagnosed in the post-transplantation period.