TONSILLAR CARCINOMA IN THE EARLY POSTOPERATIVE COURSE FOLLOWING HEART-TRANSPLANTATION

A 45-year-old male with end-stage dilative cardiomyopathy was referred for heart transplantation (HTx). Apart from severe heart disease the patient had an unremarkable medical history. Risk factors were heavy s moking and moderate consumption of alcohol. Preoperative screening inc luding a thorough ENT status did not reveal any other risk factor or c ontraindication for heart transplantation. HTx was performed three mon ths later. Immunosuppressive therapy consisted of triple-drug therapy and induction therapy with antithymocyte globulin. The patient had an uneventful perioperative course. One month after transplantation the p atient developed a rapidly growing squamous cell carcinoma of the left tonsil with local metastasis. Because of the rapid growth and size of the tumor surgical treatment was already impossible at that early tim e. Despite a course of chemotherapy the tumor continued to grow; treat ment was changed to radiation therapy resulting in partial remission. Cyclosporine and azathioprine dosages were reduced at the same time. 9 months following HTx the patient developed a rapidly growing recurren ce. As there were no further therapeutic options, immunosuppressive th erapy was completely discontinued with the patient's agreement. He die d 2 months later. The rapid tumor growth and its early manifestation f ollowing HTx suggest a preexistent occult carcinoma. A more extensive and repetitive preoperative screening in HTx candidates who are heavy smokers should be considered.