Lung transplant survival despite unexpected pulmonary metastatic thyroid cancer in the explant

A recent history of malignancy is considered by most transplant units as an absolute contraindication to transplantation. This particularly applies to the adult population, where the higher incidence of malignancy is related to age and exposure to relevant risk factors (e.g. smoking). In contrast, paediatric recipients are not extensively screened. Increasingly, children who develop chronic pulmonary graft-versus-host disease (GVHD) having survived treatment for haematological malignancies are being referred for lung transplantation. These patients do have a significant risk of secondary malignancy as a result of their underlying disease and/or prior treatments that need to be considered when being assessed for lung transplantation. We describe a 15- year-old patient who underwent cut-down lobar lung transplant for end-stage obliterative bronchiolitis secondary to GVHD that had developed as a result of haematopoietic stem cell transplantation for childhood acute lymphoblastic leukaemia. Unexpectedly, histopathological examination of the explant revealed extensive metastatic papillary thyroid cancer.