Cancer Cytopathology最新文献

In 2023, the United States set a record for organ transplants, with more than 46,00 transplants performed with organs procured from more than 16,000 deceased donors and nearly 7000 living ones.¹ With this encouraging trend reported by the Organ Procurement and Transplantation Network (OPTN), though, experts have stressed that the lifesaving operations can carry a tradeoff. Although it has happened only rarely, some donors’ metabolic disorders or nascent tumors have evaded detection before the transplant, the latter resulting in the documented transmission of glioblastoma multiforme and lung, breast, colorectal, kidney, and other cancers.

More commonly, donors can transmit parasitic, fungal, bacterial, or viral infections, including some cancer-linked pathogens such as Helicobacter pylori, hepatitis B, and hepatitis C, as well as more ubiquitous viruses such as Epstein–Barr virus and human papillomavirus (HPV). H. pylori has been linked to gastric cancer, chronic hepatitis, and liver cancer; Epstein–Barr to non-Hodgkin lymphoma; and HPV to cervical, anal, penile, and oropharyngeal cancers.

A 2021 study by OPTN’s Disease Transmission Advisory Committee (DTAC) suggested that donor-derived disease transmission occurs in less than 1% of all transplant recipients. Of the proven or probable donor transmission events, 67% involved infections, 29% included malignancies, and 6% involved other disease processes (a small percentage involved more than one kind of event).²

Gerald Berry, MD, a professor of surgical pathology at Stanford University in Palo Alto, California, and a cancer expert on the DTAC, says that the committee first tries to determine whether a transmissible event is donor-derived or originates in the recipient. “Then the subcategory is, even if it’s donor derived, was it there at the time of transplant and too small to actually detect?”

The DTAC’s work toward determining whether a malignancy can be traced back to the donor, even years after the fact, can help to establish the risk for the remaining cohort of transplant recipients. “Many times, the donor is providing organs for more than one recipient, so the biggest concern is when a recipient develops a malignancy, are the other recipients at risk?” Dr Berry says. The risk can be further characterized according to tumor type: A donor’s brain tumor that has metastasized, for example, would pose a considerably bigger danger than a far more treatable thyroid tumor.

The most significant cancer-related risk for organ transplant recipients, however, is associated with the very immunosuppressive medications that are required to prevent rejection of the organs but also can render the immune system less able to identify and kill tumor cells or battle cancer-linked infections. “The patients are so heavily immunosuppressed as part of the transplant protocol that the host versus the virus mechani

The importance of large, national/international organizations like the College of American Pathologists (CAP) and the US and Canadian Academy of Pathology for resident and fellow training cannot be overstated. However, many opportunities also exist at the locoregional level, such as pathology state societies, which vary widely in size, structure, and level of engagement but can provide valuable resources and networking opportunities for trainees. What are some specific resources, initiatives, and mechanisms that might be beneficial for local, state, and regional pathology society groups to enhance trainee experiences? The Florida Society of Pathologists (FSP) enjoys a long history of representing the interests of Florida pathologists and is an impressive example of a large state society. Key areas addressed for residents and fellows who participate in the FSP include engagement, networking, education, and advocacy. Here, we summarize several programs and initiatives that the FSP has pursued to cater to the needs of Florida's resident/fellow trainees, and we hope that this information will benefit other locoregional and state societies.