移植輸尿管癌的腫瘤起源：來自接受者還是捐贈者？

許嘉育⁴、查舫宇¹、黃昭淵¹、蔡育傑²、華筱玲³、闕士傑¹

國立臺灣大學醫學院附設醫院 ¹泌尿部，²腫瘤醫學部，³基因醫學部，⁴教學部

Tumor Origin of the Graft Ureteral Cancer: From Recipient or Donor?

Jia-Yuh Sheu⁴, Fang-Yu Cha¹, Chao-Yuan Huang¹, Yu-Chieh Tsai², Hsiao-Lin Hwa³, Jeff S Chueh¹

Department of Urology¹, Oncology², Medical Genetics³, and Medical Education⁴, National Taiwan University Hospital, Taipei, Taiwan

Purpose: To demonstrate that we can distinguish the origin of cancer in the graft ureter as recipient- or donor-derived by using the short tandem repeats (STRs) while the recipient and donor are of the same gender.

Materials and Methods: A 30-year-old Taiwanese woman had received a kidney transplant from her aunt 22 years ago. She was diagnosed with high-grade urothelial carcinoma (UC) of the left renal pelvis and ureter ten years later. She underwent the left nephroureterectomy with bladder cuff resection. During follow-up, we discovered her right native ureter and graft ureter tumors. She and her family insisted on the wish to preserve her graft kidney function. Laparoscopic right nephroureterectomy and segmental graft ureterectomy, with bladder cuff resection and Boari flap creation, were performed accordingly. The final pathology report disclosed high-grade invasive UC. In order to distinguish the origin of the graft ureteral cancer, we collected the tumor specimen, the patient's buccal mucosa, and her aunt's blood for STRs analysis by polymerase chain reaction amplification.

Results: The STRs analysis is underway, and relevant results will be presented at Taiwan Urological Association (TUA) annual meeting.

Conclusions: Genetic analysis can differentiate the tumor origin of the transplanted organ, which may further help access the prognosis and the subsequent treatment plan. However, we cannot simply compare sex chromosomes to achieve this goal for the same-sex recipient and donor. The STRs analysis can provide a useful alternative method under such conditions.