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Cancer is an important cause of mortality in patients on hemodialysis and kidney transplant recipients. Immunodepression and the genotoxic action of uremia are critical pathogenic agents. A 59-year-old man, ex-smoker, who had been on hemodialysis for seven months because of uremic degeneration of diabetic nephropathy, underwent a combined kidney-pancreas transplant in 1991, complicated by slow-resolution CMV infection. In 1993, after kidney graft failure due to chronic rejection, hemodialysis treatment was restarted with good pancreatic function. Steroid therapy was interrupted and azathioprine and cyclosporine immunosuppressive therapy maintained. In September 2007 the patient was diagnosed with two neoplasms of the oral mucosa: a well-differentiated squamous carcinoma and a spinocellular carcinoma associated with field cancerization. The tumors were resected, followed by laser treatment. Histological examination revealed squamous cell carcinoma without lymph node involvement. Azathioprine was interrupted. In January 2008 adjuvant radiotherapy to the surgical areas of the oral mucosa and neck was started. In February a verrucous nevus on the patient's chest turned out to be a spinocellular carcinoma in situ. In May 2008 recurrence of keratinizing squamous carcinoma of the oral mucosa was found, this time with nodal involvement. Cyclosporine administration was interrupted and after consultation with the oncology committee it was decided to continue with supportive therapy only, until the patient's death in August 2008.

Elderly patients are a potential source of additional organ supply for transplantation. Unfortunately, with increasing age, the chance is greater that an apparently healthy aged man will be carrying a silent prostatic carcinoma. Therefore, in order to maximize safety, intraoperatory evaluation of the prostatic gland may be required to rule out adenocarcinoma. We evaluated 14 prostatic tissue specimens obtained from "marginal" donors and examined by intraoperatory frozen sections. These were positive for carcinoma in three cases and negative in 11. Examination of permanent sections from snap-frozen tissue revealed three additional cases that were unrecognized on the initial frozen sections. The inaccuracy of the method could be explained by the difficulty, caused by freezing, of discriminating benign from malignant gland and by technical artifacts. Snap-freezing artifacts also compromised the evaluation of tumor invasion into the extraprostatic fat in 2 cases. Because of the architectural distortion, frozen sections were also ineffective in the recognition of Gleason pattern in all cases. Examination of prostatic frozen sections may be useful if the pathologist is asked to recognize only larger tumors. The estimation of small volume tumors, extracapsular extension, as well as Gleason pattern assessment suffers from an irreducible bias.