Dual Malignancy Research Articles

A case of synchronous dual malignancy with the index malignancy in the lower alveolus and a second primary malignancy in the left breast

Multiple primary malignancies are nowadays commonly detected due to better radiological techniques, greater awareness and an increase in number of elderly cancer survivors. We are reporting a rare case of patient having dual synchronous malignancy of carcinoma left lower alveolus and ductal carcinoma in left breast who presented to the department of surgical oncology and integrated breast care center. The patient is on regular follow-up, and currently, there was no evidence of recurrent or residual disease. No such case has ever been reported, and despite a thorough check on all, we are unable to find any previously reported case. Hence, to the best of our knowledge, this case is the first of its kind to have simultaneous presentation of synchronous dual malignancies involving left lower alveolar and left breast cancers.

Rare case presentation: DLBCL and plasma cell myeloma coexisting together

The synchronous presence of dual hematological malignancy is an uncommon finding. In the present case, an 82-year-old male, presented with lymph nodal mass which was diagnosed as diffuse large B cell lymphoma (DLBCL) on histopathology and plasma cell myeloma (PCM), was diagnosed with identification of clonal plasma cells in the bone marrow. Interestingly, both clonal plasma cells and lymphoma cells showed lambda light chain restriction. The patient also developed spontaneous tumor lysis syndrome which can be seen in aggressive hematopoietic malignancies. The present case is a rare presentation of synchronous dual hematological malignancies and poses diagnostic and therapeutic challenge.

The Conundrum of Dual Primary Malignancies: Four Years’ Experience of a Single Tertiary Care Institute in India

Abstract Background: Encountering more than one malignancy in a cancer patient is no longer uncommon; this increasing incidence is mostly attributable to the improvements in life expectancy, awareness, and diagnostic facilities. This article aims to highlight this institute’s experience in diagnosis and treatment of patients of multiple primary malignancies and a comprehensive review of literature. Materials and Methods: This is a descriptive study of retrospectively collected data of a single institution over 4 years from 2013 to 2016. Known cases of cancer who were diagnosed with a second primary malignancy were included in the study. Various details such as age, sex, site of disease, temporal relation of two cancers (synchronous or metachronous), family history, tobacco use, treatment given, and survival at 1 year were recorded, organized in a tabular form, analyzed, and described. Results: A total of 29 cases of dual malignancies comprising 0.74% of a total of 3879 patients of cancer were encountered. Seventy-two percent of the cases were metachronous and 5 years was the mean time interval between tumors. There was a female preponderance, and the average age was 56 years. Breast was the most common site of malignancy. At 1 year from diagnosis of second primary, 69% of the patients were alive and 27% were disease-free. Conclusion: Second primary in a patient of cancer is becoming increasingly common and the suspicion of the same should always be borne in mind during follow-up. Prognosis as well as intent of treatment depends on respective stages of the two malignancies.

Dual Gynecological Malignancies: A Case Series from Tertiary Care Center

A literature review on 1,104,269 cancer patients concluded that the prevalence of multiple primary malignancies is between 0.73 and 11.7%. The lifetime risk of developing another de novo primary after being detected with cancer is high. We report synchronous and metachronous double malignancy cases presenting in Radiotherapy Department in the Gynecology Oncology subspeciality in our hospital. A prospective observational study was carried in our Department of Radiation Oncology over a period of 3 years. A total of 25 patients reported with multiple primary cancers from 2015 to 2018. Out of 25 patients, nine patients were with synchronous presentations and the rest were with metachronous presentations. Each had a different line of management, and they were dealt with individually according to their origin of primary cancer and stage. The incidence of multiple primary cancers is on the rise, and the possibility of the same should be considered in the pretreatment evaluation. Screening procedures and careful monitoring should be done to ensure early detection and appropriate management.

A Rare Case of Synchronous Presentation of Acute Myeloid Leukemia and Lung Cancer

Background: There are very few publications on synchronous presentation of dual malignancies in the literature. Occurrence of second malignancy in a patient with a known malignant tumor is not uncommon, though synchronous primary malignancies are unusual. Case Presentation: A 77-year-old man was diagnosed elsewhere as squamous cell carcinoma of lung came to our oncology department for further management. He underwent bone marrow evaluation with the suspicious of metastasis in view of pancytopenia. On bone marrow evaluation, found to have prominence of blasts more than 20%, which were CD34 positive and CD117 positive and. Conclusion: Here we describe an unusual rare combination of synchronous presentation of acute myeloid leukemia and squamous cell carcinoma of lung.

Multiple primary malignancies

Two cases of multiple primary malignancies (two or more neoplasms without any relationship between them) are presented in this paper. The first case (65 years) was a male in whom follicular carcinoma of thyroid, metachronous neuroendocrine tumor of duodenum and urinary bladder transitional cell carcinoma were diagnosed within an eight-year period. The second case (65 years) was a female with synchronous dual malignancy of lung and urinary bladder diagnosed within a very short period of time.

Synchronous dual malignancy of papillary carcinoma thyroid and squamous cell carcinoma tongue: A case report

Synchronous dual malignancy of papillary carcinoma thyroid and squamous cell carcinoma tongue: A case report

A rare case of mediastinal nonseminomatous germ cell tumor with acute Megakaryocytic Leukemia

The most common extragonadal site of Nonseminomatous Germ Cell Tumours is the mediastinum. These are similar to their gonadal counterparts in histology but have a poorer prognosis. The association of mediastinal germ cell tumours with blood borne malignancies has been established in many case reports. However, the association of concomitant mediastinal non seminomatous germ cell tumours with Acute Megakaryocytic Leukemia is very rare with only 26 cases reported in the last 07 Decades. These patients have a very poor prognosis with only one survivor being reported till present date. AML (M7), a rare variant of Primary AML , has been more commonly associated with non seminomatous germ cell tumours. Here, we report such a rare case of dual malignancy, Non Seminomatous Germ Cell Tumour with AML (M7) which was managed at our centre.

Paraneoplastic opsoclonus-myoclonus-ataxia syndrome revealing dual malignancy

Dual malignancy has been rarely associated to paraneoplastic syndromes. We describe an unusual case of metachronous small cell lung carcinoma revealed by opsoclonus-myoclonus ataxia syndrome in a 69-year-old patient with known prostate adenocarcinoma, with positive anti-Hu and anti-Yo antibodies and good responsiveness to corticosteroids and chemotherapy.

CML as Part of Dual Malignancies-A Retrospective Analysis: Possible Mechanisms and Review of Literature.

Introduction of imatinib has changed the outlook of chronic myeloid leukaemia (CML) patients with overall survival approaching general population. Long term survival in CML patients has provided an opportunity to better study natural history and long term complications of disease as well as the treatment modalities. To study the occurrence and association of other malignancies with their outcomes in patients with CML. This is a single centre retrospective study. All CML patients case records registered with haematology clinic of a tertiary care centre in North India from 2001 to 2014 were perused and evaluated for dual malignancies. Those patients with dual malignancies were personally examined and interviewed if alive. Out of 1677 patients, 15 cases had co-existent malignancies. Four of fifteen cases of dual malignancies had CML as secondary cancer. Three had synchronous and rest 12 patients had metachronous malignancies. Only one patient was in accelerated phase, rest all were in chronic phase. Median age of the dual malignancy cases was 50years (25-66years), much younger than reported in west. The initial dose of imatinib was 400mg OD in all except one. We did not find any causal association between CML or imatinib therapy with development of secondary tumours. Interestingly in this series, incidence of CML as secondary or synchronous malignancy was higher than earlier published studies.

Dual malignancies: Do they have a worse prognosis than their individual counterparts

Background: The incidence of multiple primary cancers is reported to be between 0.734% and 11.7%. The occurrence of another malignancy of different organ in patients with known malignant tumor is known as double malignancy and is categorized into synchronous; in which the cancer occurs at the same time or within 6 months and metachronous; in which cancer follows in sequence more than 6 months apart. We review the presentation and management of synchronous malignancies in two different organs. Patients and Methods: All the patients who underwent surgery for malignancy between July 2009 and July 2013 were reviewed and the patients who had synchronous malignancies were identified. Their clinical presentation, treatment and outcome were evaluated. Results: Out of a total of 286 patients with malignancies treated in our institute, four had synchronous primary malignancies (1.39%). Three of them underwent surgery simultaneously for both the malignancies and were given adjuvant chemotherapy. One patient presented with colonic obstruction due to sigmoid carcinoma which was operated in an emergency setting and was later in the postoperative period found to have a synchronous periampullary carcinoma. Two of the patients who were managed with surgery followed by chemotherapy are doing well. Whereas the other two patients have died. Conclusion: Treatment strategies in cases of double malignancy depend on treating the malignancy that is more advanced first, or sometimes both malignancies could be treated simultaneously. If both are amenable to surgical resection as in two of our cases both the malignancies may be dealt with at the same time. The prognosis of the patients with dual malignancies depends on the aggressiveness and the stage of presentation of the more advanced tumor.

Pattern of Malignancy in Living Donor Kidney Transplant Recipients.

Background: Differences exist in the pattern of malignancy in different population groups. Most reports of malignancy have come from deceased donor transplant recipients from developed countries. Material and methods: In a retrospective analysis of 2000 patients who underwent live renal transplantation last 30 yrs (1983-2013), age, sex, type of immunosuppression, interval between transplantation and diagnosis of cancer was recorded. Results: Thirty-nine (1.95%) patients (27 M:12 F) developed 43 malignancies including 29(67.4%) with PTLD and 15 (34.8%) had other carcinomas. Five patients had dual malignancy. Mean age: 40.2 years (range 21 to 62 yrs), mean interval post-transplant was 57.9 mo (3 to 144). Of these 29 patients (1.45%) with PTLD (22M,7 F) 22 (75.8%) patients developed NHL and 7 patients (24.2%) had myeloma. Diagnosis was made by biopsy of the involved organ in 21 patients (72.4%) and aspiration cytology in 5 patients (17.2%). In 3 patients, the diagnosis was made only at autopsy. Only 5 patients (17.2%) developed PTLD within a year of transplantation. Twelve patients developed PTLD 1-5 years and 12 patients 5-10 years after transplantation. Organ involvement was extra-nodal in 18 patients (82%). Thirteen (59%) patients had disseminated disease and 9 (36.4%) had localized involvement of a single organ (brain-3, liver-1, allograft-1, perigraft node-1, retroperitoneal lymph nodes-3). Infiltration of graft was noted in 2 patients. Patients with plasma cell myeloma presented with backache, pathological fracture, unexplained anaemia or graft dysfunction. PTLD was of B cell origin in 20 cases (70%). CD 20 staining was done in 10 recent cases, of which 8 stained positive. Of the 26 patients diagnosed during life, 20 (69%) died within 1 year of diagnosis. All the other cancers were seen after 1 yr of transplant. All the patients with above cancers were managed by stopping antiproliferatives and continuing steroids and managed surgically. Initial immunosuppressive therapy consisted of cyclosporine (CsA), azathioprine(Aza) and prednisolone in 27 patients, only Aza and prednisolone in 8 patients, tacrolimus (Tac), Aza and prednisolone in 2 and Tac, MMF and prednisolone in 2 patients. Conclusion: Although the incidence of post-transplant malignancies was low, careful monitoring of renal transplant recipients for malignancies is required due to the poor response to treatment.

Dual malignancies in the setting of differentiated thyroid carcinoma

The primary objective of the study was to assess the risk for second primary malignancy after radioiodine treatment for differentiated thyroid carcinoma (DTC). Other objectives were to study the different variables associated with the occurrence of synchronous or metachronous dual malignancies in association with DTC. The patient population studied comprised patients with histopathologically proven DTC referred for radioactive iodine treatment after thyroidectomy followed up at a single centre during the period from January 1963 to March 2011. The data collected were analysed with respect to different variables associated with two primary tumours in the setting of DTC. Out of the total 8614 patients studied from 1963 to March 2011, 44 dual malignancies in association with DTC were detected, showing a prevalence rate of 0.5%. The most common site of second primary malignancy was the head and neck (H&N) in men and the breast in women. Of the 44 dual malignancies, 18 were synchronous in nature and 26 were metachronous. In the metachronous group, thyroid carcinoma was the first primary malignancy in only 5/26 patients, whereas the remaining 21 patients had thyroid carcinoma as the second primary malignancy. In 5/26 patients in whom carcinoma of the thyroid was the first primary malignancy, the second primary malignancy was breast carcinoma in two cases, renal cell carcinoma in one case, colorectal carcinoma in one case and metastatic NET of unknown primary in one case. All these five patients received radioiodine treatment with different activities. In 21/26 patients in whom thyroid carcinoma was the second primary malignancy, the most common first primary malignancy comprised H&N tumours. In this group, 12 patients had a history of external beam radiotherapy (EBRT). Among synchronous malignancies (18/44 patients), H&N tumours were the most commonly associated. There was no significant risk for second primary malignancy after radioactive iodine treatment in patients with DTC. There is increased risk for thyroid malignancy after EBRT delivered for other primary tumours, especially in children. Hence, any thyroid abnormality on long-term follow-up of patients after EBRT for other tumours should be considered carefully. H&N malignancies are the most common synchronous, metachronous and overall associated second malignancy with thyroid carcinoma.

Dual primary malignancy: a rare organ combination.

A 63-year-old female smoker was evaluated for lump over the right breast, fine needle aspiration cytology of which showed infiltrating ductal carcinoma. Investigations also revealed the presence of left upper lobe mass lesion, the biopsy of which suggested small cell carcinoma. The existence of two malignancies having different histopathologies at anatomically distinct sites suggests the diagnosis of dual primary malignancy involving the breast and the lung which, being a rare combination, prompted us to report the case.

A rare case of a synchronous anaplastic carcinoma thyroid with ductal carcinoma breast.

Dual malignancy was first reported by Billroth in 1889. Incidence of second malignancy in cancer patients is as high as 10%, but synchronous anaplastic thyroid cancer along with breast tumor is a rare entity. We present a case of a 61-year-old female with a synchronous anaplastic carcinoma thyroid with ductal carcinoma breast. The plausible association of breast cancers with thyroid carcinomas should thus be evaluated in larger cohort studies. More importantly, this report is to highlight the unusual synchronous occurrence of anaplastic thyroid cancer with ductal breast cancer and the therapeutic challenges involved in such cases.

The coexistence of clear cell renal cell carcinoma and gastrointestinal stromal tumor with portal vein metastasis, and its favorable response to sunitinib

The authors report the case of a 42-year-old man with a rare coexistence of clear cell renal cell carcinoma and gastrointestinal stromal tumor of the stomach with concurrent portal vein metastasis. After surgical resection of the two original masses, the patient was treated with sunitinib malate to control the portal vein metastasis. The metastatic lesion completely disappeared after two cycles of treatment. This is the first known reported case of synchronous clear cell renal cell carcinoma and gastrointestinal stromal tumor with distal metastasis, and the first report of the favorable efficacy and safety of sunitinib in treating this rare synchronous dual malignancy.

Random Synchronous Malignancy in Male Breast: A Case Report

We report here a case of a random synchronous male breast malignancy in a patient with a known base of tongue malignancy that was incidentally detected on a whole body 18-fluorine deoxyglucose positron emission tomography and computed tomography (18F-FDG PET/CT). Patient was referred to us for PET/CT staging and radiotherapy planning for a poorly differentiated squamous cell carcinoma of base of tongue. Histopathologically, the incidentally detected breast lesion was proven to be an invasive ductal carcinoma. 18F-FDG PET/CT being a whole body imaging modality is known to detect a considerable number of synchronous primaries. Synchronous malignancies in the head and neck area and the upper aerodigestive tract are well established. However, synchronous malignancy in male breast is reportedly uncommon. Our case is unique for the fact that a random synchronous dual malignancy of base of tongue and breast in a male patient was detected during a whole body 18F-FDG PET/CT imaging.

Endometrial Cancer with Cervical Extension Mimicking Dual Concordant Endometrial and Cervical Malignancy by F-18 FDG PET and MRI

A 35-year-old woman with endometrial cancer and cervical extension underwent F-18 FDG PET-CT [1–6] and MRI studies after resection of a cervical mass presumed to be cervical myoma. The patient underwent cervical myomectomy and the histopathologic report revealed poorly differentiated invasive carcinoma. Cervical cancer was ruled out because the patient had no history of sexual intercourse and was negative for human papilloma virus infection. The patient underwent radical hysterectomy, bilateral salpingo-oophorectomy, pelvic and para-aortic lymph node dissection, and multiple biopsies. F-18 FDG PET-CT (Fig. 1a–e) showed intense FDG uptake along the cervix wall. T2-weighted MRI (Fig. 1f, g) also revealed a mass lesion with high SI involving the anterior and posterior lips of the uterine cervix. Another area of focal increased uptake above the endometrial lesion in the left pelvic cavity was observed on PET-CT and MRI, possibly due to a functioning ovary. PET-CT and MRI were interpreted as showing a dual concordant malignant lesion due to separated FDG uptakes and high SI without any connection between the cervical and endometrial lesions. Fig. 1 F-18 FDG PET-CT (a–e) shows intense FDG uptake along the cervix wall. T2-weighted MRI (f, g) reveals a mass lesion with high SI involving the anterior and posterior lips of the uterine cervix. Together, these images were interpreted as showing ... F-18 FDG PET-CT (Fig. 2a–e) showed intense FDG uptake along the endometrium. Given the patient’s history and the fact that she was not menstruating at the time of imaging, this intense uptake was interpreted as another pathologic lesion, suggesting dual primary lesions. A suspected heterogeneous mass lesion along the endometrium suggesting concordant endometrial cancer was found on MRI (Fig. 2f, g). Endometrial cancer with cervical extension is sometimes difficult to differentiate from primary cervical cancer. Fig. 2 F-18 FDG PET-CT (a–e) shows intense FDG uptake along the endometrium. MRI (f, g) shows a suspected heterogeneous mass lesion along the endometrium suggesting concordant endometrial cancer The final histopathologic report showed poorly differentiated endometrial adenocarcinoma with cervical extension, although the FDG PET-CT and MRI findings were suggestive of concordant cervical and endometrial cancer. Although histopathologic confirmation is necessary for final diagnosis, MRI and FDG PET-CT studies may aid in the differential diagnosis. A metastatic cervical mass from endometrial cancer clinically presenting as cervical myoma is rare. This case suggests that poorly differentiated endometrial cancer may extend into the cervix, presenting as cervical myoma, and the possibility of a metastatic mass should be considered in the differential diagnosis when dealing with cervical myoma.

Single-Stage Minimally Invasive Management of Dual Malignancy in a Solitary Kidney and Crossover Adrenal Metastasis: Role of Bench Dissection and Autotransplantation

Introduction: Double malignancy in a solitary functioning renal unit with crossover adrenal metatstasis in a patient with good performance status poses a challenging problem to the clinician. In situ partial nephrectomy or probe ablative therapies have been popularly practiced for such scenarios.1 We report a similar presentation that was managed by laparoscopic radical nephrectomy, bench dissection, and removal of the lesions followed by autotransplantation. The video demonstration of the operative exercise spans over 7 minutes 30 seconds. Materials and Methods: A 65-year-old man experienced left flank pain since 1 month. He underwent right radical nephrectomy and left adrenalectomy for crossover metastasis through bilateral subcostal incisions 2 years ago. Left scapula was resected for metastatic deposits 1 year ago. American Society of Anesthesiologists (ASA) score was Grade I. Blood profile was normal. Imaging revealed solitary functioning left kidney with two heterogeneously enhancing lesions 3.5×2.5 and 2×1.5 cm involving the upper and lower pole, respectively, and an enhancing lesion in contralateral adrenal. Renal vein and other organs were free of tumor. Laparoscopic approach was planned. Results and Discussion: Right laparoscopic adrenalectomy was conducted in left lateral decubitus. Dense adhesions were encountered. Adrenalectomy specimen was trapped in a retrieval bag. Thereafter in right lateral decubitus, left radical nephrectomy was performed. Upper pole dissection was difficult due to previous adrenalectomy. Specimens were extracted through a right lower quadrant incision. Warm ischemia time was 2 minutes. The kidney was immersed in ice slush and perfused with cold perfusate. In bench, both the lesions were removed with 1-cm cuff of healthy parenchyma. Renorrhaphy was performed with No 2/0 polyglactin suture. Autotransplantation was conducted through the same incision. Patient experienced short period of acute tubular necrosis postprocedure after which renal function normalized. He resumed normal activities by 1 week. Histopathology of renal lesions conferred to clear cell renal carcinoma Grade II, margins free. Histopathology of adrenal revealed metatstatic deposits of clear cell carcinoma. He received targeted chemotherapy. Small volume metastasis in solitary kidney in a patient with good performance score demands selective ablation with adjuvant therapy. In situ partial nephrectomy for dual lesions may subject the renal unit to increased warm ischemia and consequences thereof. Laparoscopic radical nephrectomy and bench dissection limits the warm ischemia incurred, provides optimum renal cooling, and enables maximum nephron salvage. Also, no facilities for cryoablation were available. Hence, we adopted this approach. Bench dissection with autotransplantation has been practiced in limited scenarios so far, and in most situations incisional approach has been employed both for extirpation and retrieval.2 In this scenario, extirpation was undertaken through minimally invasive approach. The morbidity profile and cosmesis were appreciable. Autotransplantation avoided the need for permanent hemodialysis that adds to patient morbidity and increases the financial burden borne by the patient. No competing financial interests exist. Runtime of video: 7 mins 30 secs

A case of dual malignancy: Presenting the necessity for extensive sampling for pathologic examination

A patient diagnosed with early squamous-cell carcinoma (SCC) with microinvasion was treated by surgical excision followed by histopathologic evaluation. During surgery, all the nodes appeared free of tumor other than a single level-3 node which looked suspicious and enlarged. Surprisingly, the node, instead of showing SCC showed features suggestive of “etastatic papillary thyroid carcinoma.” The characteristics of papillary thyroid carcinoma (PTC), their usual histopathologic features and treatment are discussed. The aim of this paper is to present the case of a patient with dual malignancy—oral SCC and PTC in an adult male, which was diagnosed accidently because the protocol of complete surgery and extensive sampling for pathologic examination was followed and thus emphasizes on the necessity for the same.