Headlines About Doc Who ‘Catches’ Patient’s Cancer Are Popping Up Again

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A unique case report of accidental cancer transplantation from a patient to their surgeon has resurfaced decades years after being published in the New England Journal of Medicine.

The recent headline in the Daily Mail blared, “Surgeon Catches CANCER From Patient in First-of-Its-Kind Case,” as if the findings were new. Numerous other publications ran with the story as well.

Yet the report was originally published in 1996. It details the case of a 32-year-old man who “underwent emergency surgery to remove a malignant fibrous histiocytoma from his abdomen.” The patient died shortly after surgery from postoperative complications.

During the procedure, the surgeon accidentally injured his left palm while placing a drain. Though he immediately disinfected and dressed the lesion, he later developed a hard, circumscribed, tumor-like swelling, 3 cm in diameter, on that same palm at the base of his middle finger, which was the exact spot he was injured.

A histologic examination found that it was the same type of tumor that his patient had, now known as undifferentiated pleomorphic sarcoma (UPS). Two years after the tumor was removed, the surgeon was in good health and the cancer had not recurred or metastasized.

This isn’t the first time this case report has resurfaced — it also attracted news coverage in 2016 and 2023. What is it about this 30-year-old case that continues to draw attention?

Nicholas Hornstein, MD, PhD, a medical oncologist at the Northwell Cancer Institute at Manhattan Eye, Ear & Throat Hospital in New York City and the R.J. Zuckerberg Cancer Center in North New Hyde Park, New York, told MedPage Today that the case taps into fears that people have about contagion.

“Anytime something is transmitted, especially cancer, from a patient to a provider, it definitely raises some eyebrows,” Hornstein said. “I think it also begs the question, is cancer spreadable? Can you get it just being around another person?”

The short answer, he said, is no, but the more nuanced answer is that a few cancer cells form in people’s bodies every day, which their immune systems usually recognize and clear out, although sarcoma is known to downregulate immune surveillance markers.

Hornstein pointed out that there was an inflammatory reaction to the surgeon’s tumor, which was likely his immune system trying to clear out those cancer cells. That robust immune response was a good sign because, as far as is known, the cancer didn’t enter the surgeon’s bloodstream and spread elsewhere, he noted.

This rare case likely occurred because of the unique combination of “having a large amount of the patient’s cancer cells coming into this physician’s hand … and the fact that this cancer is more notoriously difficult to clear with an active immune system,” he explained.

Benjamin Nacev, MD, PhD, a sarcoma physician-scientist at UPMC Hillman Cancer Center at the University of Pittsburgh School of Medicine, told MedPage Today that in this case, a pathologist had conducted morphological tests, and DNA testing was also performed, including short tandem repeat polymorphisms, a test used frequently in the lab to validate cell lines.

These analyses showed “that there was not only a morphological match, but a genetic match between the two tumors, really supporting the fact that there was a transplantation of this tumor into the surgeon,” he said.

Hornstein also noted that human leukocyte antigen testing found that the surgeon and patient didn’t have similar immune systems.

Nacev pointed out that if the same situation happened today, there would likely be more in-depth exome or genome sequencing of the original tumor and the surgeon’s tumor, and there would also likely be better practices that would have prevented the injury in the first place. In the rare cases where surgeons cut themselves during a procedure, the biggest concern is not cancer transplantation, but rather infectious etiologies like hepatitis or HIV, he added.

Hornstein said that prophylactic treatment and antivirals are options in those cases, but with cancer it doesn’t make sense to undergo chemotherapy preventatively.

“We don’t generally think of cancer as being transmissible. I think it’s a very rare event,” Nacev noted. “Typically, you can’t just take tissue from one individual and put it into another individual. The immune system would attack that as if it was a foreign pathogen, like a virus or bacteria.”

That’s also why organ transplant recipients take immunosuppressives and why donor screening criteria are stringent, he added.

Nacev said rare case reports like this are useful tools. “Outliers in biology and outliers in medicine offer a really great opportunity for us to think scientifically about what makes this different and what might we learn about the biology of UPS or cancers in general.”