Immunoediting is crucial in cancer development and progression. The immunosuppressant treatment after kidney transplantation increase cancer risk. Many solid cancer have been described. However Breast cancer has been rarely described. Data from kidney transplantation unit in Charles Nicolle Hospital in Tunisia, recorded during 31 years (1986 to 2017) lists 2 cases of post transplantation breast cancer within 720 kidney grafted patients.Case 1
We report the case of a 50-year-old woman who was transplanted at the age of 34 year because of undetermined nephropathy. Sixteen years post kidney transplantation, she was diagnosed with breast cancer. Ultra sound, mammogram and computed tomography imaging confirmed the presence of a mass in the left breast. A complete mastectomy of the left breast was performed. Histopathological analysis revealed invasive ductual carcinoma. The patient had lymph node negative cancer. Estrogen receptor and progesteron receptor were positive. She had adjuvant radiation therapy and hormone therapy. Suppressant treatment which was based on Ciclosporin was converting to Sirolimus. Otherwise, the patient did not have any disturbance of allograft function.Case 2
We report the case of 42-year-old woman who was transplanted at the age of 32 year because of glomerular nephropathy (Segmental and Focal Hyalinosis). Ten years post kidney transplantation, she was diagnosed with breast cancer. Ultra sound mammogram and computed tomography imaging confirmed the presence of the mass in the right breast. A lympectomie was performed. Histopathological analysis revealed invasive ductual carcinoma with a contingent of comedocarcinoma. The patient had lymh node positive cancer. Estrogen and progesteron receptor were positive. She had neoadjuvant chemotherapy, neoadjuvant radiation therapy and hormone therapy. The immunosuppressant treatment was converting to sirolimus. The patient had a chronic dysfunction of the allograft remained stable.Conclusion
Breast cancer has been rarely reported in the literature. Our cohort of 720 allograft included 2 patients during 32 years. We showed that Immunosuppressant treatment can however be preserved using proliferation signal inhibitors. Cancer can be treated without losing the graft.