Multiple Primary Malignant Tumors: A Condition Which Should Not Be Overlooked

Abstract

SESSION TITLE: Student/Resident Case Report Poster - Lung Cancer I SESSION TYPE: Student/Resident Case Report Poster PRESENTED ON: Tuesday, October 25, 2016 at 01:30 PM - 02:30 PM INTRODUCTION: Multiple Primary Malignant Tumors (MPMT) are defined as two or more separate neoplasms in different sites. Prevalence of MPMT ranges between 0.73% and 11.7%. MPM involving ovary-colon, ovary-breast, and breast-breast are the most common associations [1]. We present a unique case of squamous cell lung carcinoma presenting in synchronicity with B-cell lymphoma. CASE PRESENTATION: A 62 year-old Puerto Rican male with history of extensive tobacco use was admitted complaining of worsening weakness associated with significant weight loss. His past medical history includes HTN, DM and HCV infection. Physical examination revealed an ill-appearing cachectic man with bilateral cervical lymphadenopathy and decreased breath sounds in right upper lung field. On admission he was found to have severe hypercalcemia of 13.4 mg/dL. Chest CT showed lobulated mass in right upper lobe measuring 9.9 x 10.6 x 12.8 cm extending into the hilum with associated mediastinal and subcarinal lymphadenopathy. FNA and Excisional biopsy of left cervical lymph node were positive for B-cell lymphoma. Bronchoscopy with biopsy of chest mass was positive for Squamous cell carcinoma. Ultimately the patient did not wish to treat these cancers. DISCUSSION: MPMT can be “synchronous” when the second primary cancer is diagnosed within 6 months of the first, or “metachronous” when the second primary cancer is diagnosed more than 6 months after the first. Synchronous MPMT have been identified with increasing frequency probably due to more comprehensive screening protocols. Considering this patient’s significant smoking history; CT findings with a pulmonary mass; and associated cervical lymphadenopathy he had a high probability of primary lung cancer. As recommended by ACCP evidence-based clinical practice guidelines, decision was made to perform FNAC of the cervical lymph node. This is the least invasive method to confirm the diagnosis, provide staging, and guide treatment plans. FNAC result was positive for B-cell lymphoma. Patient’s clinical presentation and large lobulated pulmonary mass on CT raised suspicion for different primary pulmonary pathology. Bronchoscopy and biopsy were pursued revealing a synchronous MPMT. Anchoring to the diagnosis of B-cell lymphoma would have masked the separate primary lung malignancy. CONCLUSIONS: We should have high clinical suspicion for possibility of synchronous MPMT. Depending of the types of MPMT significant differences in treatment options and survival rates exist. Reference #1: Irimie, A,. et al,. Multiple primary malignancies - epidemiological analysis at a single tertiary institution. J Gastrointestin Liver Dis. 2010 Mar;19(1):69-73. DISCLOSURE: The following authors have nothing to disclose: Tanya Helm, Nanda Din, Xavier Fonseca, Rosemarie Flores No Product/Research Disclosure Information