Post-transplant malignancies cause significant morbidity and mortality. In this thesis we investigated malignancies in renal transplanted patients from a clinical viewpoint. The use of regional tumour registries considerably improved identification of pre- and post-transplant malignancies, which are generally underreported in transplant registries. Despite previously adequate cancer treatments with favourable prognosis, patients with pre-transplant malignancies showed higher incidence of post-transplant cancer and reduced survival compared to a 1:3 ratio matched control group of patients without a previous cancer from the Collaborative Transplant Study in Europe. A careful oncological surveillance pre-transplant and post-transplant is recommended. A multidisciplinary team evaluated the immunosuppressive and oncological treatment in a clinical prospective observational study of 120 renal transplanted patients with post-transplant malignancies. In two-thirds of the patients immunosuppression was possible to change to mTOR inhibitors with anti-tumour effects. Oncological treatment was adjusted in 50% of patients with solid or haematological tumours. MDT assessments are essential for optimizing treatment of post-transplant malignancies. Number of previous cutaneous squamous cell carcinoma (SCC) posed the most significant risk variable in predicting subsequent SCCs during a two-years study of 73 transplanted patients with at least one SCC. Incidence of transplant-derived tumours is 5 times higher than anticipated. Three of eleven cancers in urinary tract and two of four cancers in the transplants were transplant-derived. Five of eleven cancers of the urinary tract were BK-virus positive. Allograft immune response against these tumours offer new options for cancer treatment such as immunomodulatory or anti-viral treatment in combination with modified immunosuppression.

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A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg; in partial fulfillment for the degree of Master of Medicine (Anatomical Pathology) 2015. / Cytological criteria distinguishing phyllodes tumour of the breast from fibroadenoma. Fibroepithelial lesions of the breast include fibroadenomas and phyllodes tumours. Fibroadenomas are benign tumours, whereas phyllodes tumours range from benign, indolent neoplasms to malignant tumours capable of distant metastasis and occasionally resulting in death. The aim of this study was to determine whether there are statistically significant differences between fibroadenomas and phyllodes tumours with regard to selected cytological features. A ten year retrospective review was performed of patients who had an excision of a fibroadenoma or phyllodes tumour, and on whom a pre-operative fine needle aspirate was performed. The following cytological criteria were assessed: number of stromal and epithelial fragments, stromal to epithelial ratio, stromal cellularity, Stromal borders, stromal atypia and proportion of background wavy spindled cells. The patient age, tumour laterality and tumour size were recorded. Fifty fibroadenomas and 17 phyllodes tumours were included. When compared with phyllodes tumours, fibroadenomas had a larger number of epithelial fragments, a smaller number of stromal fragments and a lower stromal to epithelial ratio. The stroma tended to be less cellular and less atypical compared with phyllodes tumours and the background cellular population contained less spindled cells. Fibroadenomas and phyllodes tumours differ with regard to various cytological features, possibly aiding in their distinction on fine needle aspiration biopsy. / AC2016