Multiple Synchronous Tumors in a Patient: A Rare Entity

Abstract

A 77-year-old man was admitted to our hospital due to melena with no other symptoms from the upper gastrointestinal tract mentioned. Past medical history included heterozygous βthalassemia, arterial hypertension, and cholecystectomy. Esophagogastroscopy showed a hiatal hernia and a large ulcerative lesion at the gastroesophageal junction. Biopsy revealed malignant adenocarcinoma. Colonoscopy had no pathologic findings. Laboratory tests were within normal values, except for slight anemia. CT scan of the abdomen demonstrated three small cystic hepatic lesions and a welldefined lesion in the upper pole of the left kidney which measured 6×6.8 cm with soft-tissue density. Chest and brain CT scans as well as bone scan demonstrated no metastatic lesions. Further investigation of the abdomen with MRI demonstrated a primary neoplasm in the upper lobe of the left kidney, without participation of the adrenal. It also revealed that the hepatic pathology represented simple cysts (Fig. 1). Although the creatinine level was normal, a dynamic kidney scan showed the participation of the right kidney in a percentage of 54%. Additionally, the dermatologists and the plastic surgeons examined the patient, and no skin lesion was found. Surgical treatment was decided. After preoperative evaluation, an esophagogastrectomy and a left radical nephrectomy through a left thoracoabdominal incision were performed, without complications. The histology report showed a poorly differentiated ulcerative adenocarcinoma of the gastroesophageal junction and the lower esophagus infiltrating the wall and the surrounding adipose tissue (TNM Classification of Malignant Tumours (TNM)/American Joint Committee on Cancer (AJCC) stage pT3N0), a chromophobe renal cell carcinoma of the left kidney with perforation of the renal capsule and infiltration of the perirenal fat (TNM/AJCC stage pT3aN0), four small renal oncocytomas with organoid configuration, solid and acinar structures, and thin fibrovascular stroma, multiple diminutive foci of renal papillary adenomas in the vicinity of the oncocytomas and throughout the renal parenchyma with psammoma microcalcifications, and a small angiomyolipoma (0.5 cm in the greatest diameter) located in the proximal perirenal fat. Immunohistochemistry confirmed the above P. Tsipas :G. Laoutides : C. Kotoulas (*) Department of Cardiothoracic Surgery, 401 General Military Hospital of Athens, Kifissias Ave 38, Ampelokipoi, Athens 11526, Greece e-mail: info@kotoulas.com