A doctor operating on a cancer patient accidentally ‘transplanted’ the disease into himself, in what is believed to be a one-of-a-kind event.
A 32-year-old man from Germany had been diagnosed with a rare type of cancer and was having a tumor removed from his abdomen.
While in surgery, the doctor performing the procedure accidentally cut his hand, but the wound was disinfected and bandaged immediately.
However, five months later, the 53-year-old surgeon noticed a small lump developing where he had injured himself months earlier and sought care.
The lump turned out to be a malignant tumor and tests showed it was genetically identical to the cancer suffered by his former patient.
This lead the medical team who treated him to conclude he had caught the cancer when tumor cells entered the cut on his hand.
Authors of the case report called this an usual situation because in a traditional transplant, the body mounts an immune response and rejects any foreign tissue, and they would have expected the same in the doctor’s case.
However, given the tumor’s development, and growth, it suggests the surgeon’s body had an ‘ineffective antitumor immune response.’
Case report authors said the doctor’s body likely did not mount an appropriate response to the tumor cells ‘transplanted’ from the patient’s body (stock image)
While the case was originally reported in 1996, it has resurfaced with renewed interest.
Published in The New England Journal of Medicine, doctors detailed the ‘accidental transplantation’ of the patient’s malignant fibrous histiocytoma – a rare type of cancer that forms in soft tissue with just 1,400 diagnoses per year.
The doctor injured the palm of his left hand when trying to place a drain in his patient while performing surgery to remove the cancer from the patient’s abdomen.
The wound was immediately disinfected and bandaged.
While the cancer patient’s initial surgery was successful, he died following complications after the procedure.
Five months later, a hard 1.2inch ‘tumor-like swelling’ appeared at the base of the doctor’s left middle finger and he visited a hand specialist.
An ‘extensive’ exam was conducted, including numerous laboratory and blood tests, which revealed no abnormal findings.
The tumor was removed anyway and examining the mass under a microscope revealed it was also a malignant fibrous histiocytoma.
The physician who had been treating both the cancer patient and the surgeon ‘raised the question whether the tumors were related.
Samples of both tumors were further analyzed and were determined to be ‘identical.’
They both had the same types of cells and arrangement of those cells, meaning the surgeon may have unknowingly transferred cancer cells from the patient to the cut in his hand, allowing the disease to take root and grow in his body.
The authors wrote: ‘Normally, transplantation of allogeneic tissue from one person to another induces an immune response that leads to the rejection of the transplanted tissue.
‘In the case of the surgeon, an intense inflammatory reaction developed in the tissue surrounding the tumor, but the tumor mass increased, suggesting an ineffective antitumor immune response.’
The authors speculate the tumor ‘escaped immunologic destruction through several mechanisms,’ including changes to molecules in its cells and a failure in the surgeon’s body to recognize and attack tumor cells effectively.
Two years after the surgeon had his own tumor removed, there were no signs the cancer had spread or returned.
In a recent study, researchers detailed cases of heart transplant recipients adopting their donors’ preferences and memories
Above are findings from the analysis of the patient’s tumor (left) and the surgeon’s tumor (right). They revealed the two men had ‘identical’ tumors
Doctors noted the case was interesting because transplanted tissue differs from the host tissue and is usually targeted by the host’s immune system in an attempt to destroy it.
This is why organ recipients must take immunosuppressive drugs to make sure their body does not reject the transplanted organ.
But while the surgeon developed inflammation around his original cut, his immune response did not stop the tumor from growing.
Cases like the surgeon’s are extremely rare and there are no statistics on ‘transplanted’ cancer.
A 2013 review of these cases published in the Cold Spring Harbor Perspectives in Medicine, states there is no estimation of risk for transmitting cancer from donor to recipient and there is limited data on the subject.
Report authors wrote: ‘The incidence of any cancer transmission is so low that sporadic case reports are the main source of information.’
An earlier review from 1993 that looked at data from the 1970s also found there were only ‘sporadic’ reports of cancer being transmitted through organ donation.
The 2013 review added: ‘The low frequency and very variable stage of cancers mean that definitive risk calculations are impossible.’
However, the authors continued, the data is ‘highly likely to underestimate the true incidence.’
Using the limited data available, authors of the 2013 report found cancers known to have been transmitted from donor to recipient on at least one occasion include, breast cancer, colon cancer, liver cancer, lung cancer, melanoma, ovarian cancer, prostate cancer and renal cancer.
