Multiple Primary Malignant Tumors Research Articles

Successful surgical treatment of metachronous carcinoma of the appulla of Vater and ductal carcinoma of the distal parts of the pancreas

Background. Currently, there is a steady trend towards an increase in the incidence of both synchronous and metachronous multiple primary malignant tumors (MPMT). However, metachronous polyneoplasia of the pancreatobiliary tract is relatively rare, and there have been very few reports on successful treatment of this malignancy. Case presentation. In September 2014, the patient K. was diagnosed with adenocarcinoma of the ampulla of Vater (T2N0M0, stage Ib) and underwent gastropancreatoduodenal resection with the creation of pancreatic-gastric anastomosis at the Abdominal Department of Cancer Research Institute of Tomsk National Research Medical Center. There were no complications in the postoperative period. At a 6.5-year followup, no evidence of disease progression was found. In April 2021, a follow-up examination conducted at the Cancer Research Institute revealed a large lesion on the distal part of the pancreatic stump with no clinically significant manifestations. Diagnosis of MPMT was confirmed by transgastric endoscopic ultrasound-guided biopsy. Histological and immunohistochemical examinations revealed undifferentiated ductal carcinoma of the pancreas. Considering the metachronous tumor localization, pancreatic stump extirpation with resection of the posterior wall of the stomach and splenectomy was performed. No complications occurred in the postoperative period. The patient received replacement therapy for exocrine pancreatic insufficiency and individual correction of carbohydrate metabolism. At a 15-month follow-up, liver metastases were detected, and palliative chemotherapy was administered. The patient died 6 months later due to disease progression. The survival time was 99 months after the first surgery and 21 months after the second surgery. Conclusion. We report a rare case of metachronous cancers of the ampulla of Vater and pancreatic stump developed with an interval of 6.5 years. The patient underwent successful curative resections consecutively. The overall survival time from the date of diagnosis was 99 months.

A case of Ph+ acute lymphoblastic leukemia and EGFR mutant lung adenocarcinoma synchronous overlap: may one TKI drug solve two diseases?

BackgroundPhiladelphia chromosome positive (Ph+) acute lymphoblastic leukemia (ALL) refers to ALL patients with t(9;22) cytogenetic abnormalities, accounting for about 25% of ALL. Lung adenocarcinoma (LUAD) is the most common pathological type of non-small-cell lung cancer, which has a frequency of approximately 45% cases with mutations in EGFR. Both Ph+ ALL and EGFR mutant LUAD are involved in the pathogenesis of the abnormal activation of the tyrosine kinase pathway. Although the second primary hematological malignancy after the treatment of solid tumors is common in clinics, the synchronous multiple primary malignant tumors of hematological malignancy overlap solid tumors are uncommon, even both tumors involved in the pathogenesis of the abnormal activation of the tyrosine kinase pathway are extremely rare.Case presentationAn 84-year-old man with fatigue and dizziness was diagnosed with Ph+ ALL. Meanwhile, a chest CT indicated a space-occupying lesions, characterized by the presence of void, in the right lower lope with the enlargement of mediastinal lymph node and right pleural effusion. After a few weeks, the patient was diagnosed with LUAD with EGFR exon 19 mutation. Both tyrosine kinase inhibitors (TKI) (Flumatinib) and EGFR-TKI (Oxertinib) was used for the patients, and finally have controlled both diseases.ConclusionAs far as we know, we for the first time reported a case of Ph+ ALL and EGFR mutant LUAD synchronous overlap, of which pathogenesis is related to abnormal tyrosine kinase activation. This patient was successfully treated with two different TKIs without serious adverse events.

Clinical analysis of multiple primary gastrointestinal malignant tumors: A 10-year case review of a single-center.

Multiple primary malignant tumors (MPMTs) was first described by Billroth as early as 1889, with the first report published by Warren and Gates in 1932. Since then, numerous cases have been reported. A literature review of 1104269 patients with cancer revealed that the incidence of MPMTs ranged from 0.73 to 11.7%. In recent years, however, there has been a significant upward trend in the incidence of this phenomenon, which may be associated with many different factors, including the advancement of modern diagnostic procedures facilitating the examination and diagnosis of more MPMTs, increased exposure to chemotherapy and radiotherapy that exacerbate the risk of new malignant tumors in patients with cancer, and prolonged survival of patients with cancer allowing sufficient time for the development of new primary cancers. To analyze the incidence, clinical features, treatment factors, prevalence, and prognosis of patients with MPMTs in the gastrointestinal tract treated in a single center. Additionally, we analyzed the different tumor combinations, time interval between the occurrence of tumors, and staging. This retrospective cohort study analyzed 8059 patients with pathologically confirmed gastrointestinal malignant tumors treated at the Gansu Province Hospital in Lanzhou, Gansu, China between June 2011 and June 2020. Of these, 85 patients had MPMTs. The clinical features, treatment factors, prevalence, and prognosis of this latter cohort were analyzed. The incidence of MPMTs in patients with gastrointestinal malignant tumors was 1.05% (85/8059), including 83 double primary malignant tumors and two triple primary malignant tumors of which 57 (67.06%) were synchronous MPMTs (SMPMTs) and 28 (32.94%) were metachronous MPMTs (MMPMTs). The most frequent associations were found between the rectum colon cancers within the SMPMT category and the gastric-colon cancers within the MMPMT category. For the MMPMTs, the median interval was 53 months. The overall 1-, 3- and 5-year survival rates from diagnosis of the first primary cancer were 91.36%, 65.41%, and 45.97%, respectively; those from diagnosis of the second primary cancer were 67.90%, 29.90%, and 17.37%, respectively. MPMTs in the gastrointestinal tract have a high incidence and poor prognosis. Thus, it is necessary to perform both gastroscopy and colonoscopy in patients with gastrointestinal tumors. Multidisciplinary comprehensive diagnosis and treatment may improve the diagnosis rate and treatment efficiency of MPMTs.

DOPAMINE AND NOREPINEPHRINE CONTENT IN THE CEREBRAL CORTEX OF BALB/C NUDE MICE WITH MULTIPLE PRIMARY MALIGNANT TUMOURS

The increase in patients with multiple primary malignant tumors (MPMT) determines the need to study their pathogenesis. An important role in the functioning of brain neurons belongs to norepinephrine (NA) and dopamine (DA), which can contribute to tumor development in immunodeficient mice of both sexes.
 The purpose of our work was a comparative analysis of dopamine and norepinephrine content in the cerebral cortex of immunodeficient mice of both sexes during isolated and combined growth (MPMT model) of experimental tumors.
 Materials and Methods. 56 BALB/c Nude mice were divided into 7 groups: 4 groups of females (intact, mice with standard subcutaneous inoculation of B16/F10 melanoma or Lewis lung carcinoma (LLC), mice with MPMT model – subcutaneous injection of a tumor cell suspension); 3 groups of males (the same groups as for females, except LLC). ELISA technique was used to detect NA and DA content.
 Results. In the cerebral cortex of intact females, DA level was higher (3.7 times) and NA level was lower (1.8 times) when compared to males. In all types of tumor growth, monoamine level decrease was observed in animals of both sexes. In females, DA decrease was 57.2 % and 65.8 % with isolated B16/F10 melanoma growth and LLC, and with MPMT it reached 70 %. In males, DA decreased significantly only with MPMT – by 37.6 %. NA in females decreased in case of LLC and MPMT by 26.2 % and 28.1 %, respectively. In males, NA decreased with B16/F10 melanoma and MPMT by 53.3 % and 43 % respectively (p<0.0001 in all cases). In females, there was a more than twofold increase in the ratio of stress-implementing NA and stress-limiting DA (NA/DA) levels, while in males there was a decrease in this index. This was consistent with the large tumor sizes (2–3 times larger) in case of MPMT in females.
 Conclusion. The results indicate the participation of brain neurotransmitters in the development of multiple primary malignant tumors in BALB/c Nude mice of both sexes and lower stress resistance in females.

ХАРАКТЕРИСТИКА ПЕРВИЧНО-МНОЖЕСТВЕННЫХ ЗЛОКАЧЕСТВЕННЫХ НОВООБРАЗОВАНИЙ У РАБОТНИКОВ, ПОДВЕРГШИХСЯ ХРОНИЧЕСКОМУ ОБЛУЧЕНИЮ

Purpose: To characterize multiple primary malignant tumors (MPMTs) in workers occupationally chronically exposed to ionizing radiation. Material and methods: The study included 22,377 workers employed at reactors, plutonium-production plant and radiochemical plant of the Mayak Production Association (PA) who had been hired in 1948–1982. The study considered cases of MPMTs (verified with the morphological examination) that had been diagnosed in workers before 31 December 2018. The paper describes the structure and provides the comparative characteristics of synchronous and metachronous MPMTs. Results: 320 cases of MPMTs that were verified with the morphological examination were registered in the cohort: 68.4 % in males and 31.6 % in females. 3 and more malignant tumors were registered in 20 % of workers with MPMTs. MPMTs accounted for 10.5 % of total malignant tumors registered in the cohort. Synchronous MPMTs accounted for 22.8 % in males and for 18.8 % in females. 36.6 % of metachronous MPMTs were diagnosed with an interval of more than 10 years. The structure of MPMTs was dominated by tumors of digestive organs, skin, genital organs (both sexes), respiratory organs (for males), and breast (for females). As for a histological type of tumor, adenocarcinomas and basal-cell carcinomas (both sexes), squamous-cell carcinomas (for males), ductal and lobular tumors (for females) were the most frequent. Groups of workers with synchronous and metachronous MPMTs demonstrated some significant differences: synchronous MPMTs were diagnosed in later age than the primary metachronous tumor; the numbers of smokers and heavy alcohol drinkers were bigger in the group of workers with synchronous MPMTs, as well as the smoking index. Neither radiation doses nor the duration of occupational exposure at a date of diagnosis of synchronous MPMTs and a primary metachronous tumor were significantly different. Compared to the entire study cohort, the number of workers occupationally exposed at high doses was bigger in workers with MPMTs (above 1.0 Sv for external gamma-ray exposure, and above 1.0 Gy for internal alpha exposure). Conclusion: MPMTs in workers of the nuclear enterprise were characterized in relation to non-radiation and occupation-related factors. In the future it is planned to assess the impact of the occupational radiation exposure on the risk of MPMTs in workers of the study cohort considering non-radiation factors.

Simultaneous ampullary adenocarcinoma and gist of the stomach a rare case of multiple primary malignant tumors – a case report

Simultaneous ampullary adenocarcinoma and gist of the stomach a rare case of multiple primary malignant tumors – a case report

An Unusual Case of Triple Synchronous Malignancies in a Middle-Aged Male Smoker: A Case Report and a Brief Literature Review.

The presence of multiple primary malignant tumors (MPMTs) in a single individual is unusual. Depending on when the tumors are diagnosed, they can be classified as synchronous or metachronous. In the literature, metachronous tumors are more frequently described than synchronous ones. The vast majority of synchronous tumor cases involve two primary tumors, usually located in the same anatomic location, such as the prostate and bladder; or esophagus and stomach – organs that have been subject to field cancerization. A triple synchronous tumor arising in different anatomical locations is extremely rare. We present a unique case of a middle-aged man with synchronous lung, esophageal, and renal cancers.

Multiple Primary Malignant Tumours

Two or more histologically distinct malignancies in one individual are termed as multiple primary malignant tumours (MPMT). The incidence of these cases has been rising over the past few decades, primarily due to improved methods for cancer screening, diagnosis, treatment, and follow-up. They can show up as metachronous lesions later on or synchronously with the index malignancy. The precise aetiology is still unknown; however, a number of epidemiological variables have been proposed as potential risk factors. Modern imaging techniques are very helpful in the diagnosing process. Physician awareness is essential in order to raise suspicions about the potential for MPMT and to conduct appropriate investigations. There are currently no universal protocols based on evidence; instead, management is empirical and dependent on the judgments made by interdisciplinary teams.

The place of multiple primary cancers in urologic oncology

Background. In Russia, statistical record of multiple primary cancers has been implemented only recently, and there are few scientific publications. Multiple primary malignant neoplasms of the urologic locations are described even less in literature. The problem of multiple tumors becomes more pressing with each passing year.Aim. To perform retrospective study of statistical data on urologic multiple primary cancer from one department.Materials and methods. An analysis of retrospective data from medical histories of patients who received treatment between 1997 and 2020 in urologic oncology departments where the authors worked: Omsk Regional Oncological Dispensary (1997–2005), Moscow Oncology Clinical Hospital No. 1 (2003–2005), Moscow City Oncology Hospital No. 62 was performed.Results. During the analyzed period, 23,299 hospitalizations including repeated were registered for 19,040 patients. Year-by-year data analysis showed 1,817 patients with multiple tumors, among them 1,508 patients with multiple primary malignant tumors, one and/or more of which were urologic pathology. The most common diseases were bladder cancer (n = 631), renal cancer (n = 618), prostate cancer (n = 614). A significant number of patients (n = 125; 8.29 %) had multiple tumors in 3 or more urologic locations. Tumors of the upper urinary tract were observed in 78 patients, testicle – in 36, penis – in 22, adrenal gland – in 10, urethra – in 4. Women comprised 28.05 % (n = 423) of the patients, men – almost 72 % (n = 1,085). This patient distribution by sex reflects the fact that urologic oncology includes both tumors of the urinary tract and male sex organs.Conclusion. Currently, the questions of terminology of multiple primary tumors remain open: multiple primary, multilocular, bilateral tumors, and mixed tumors. There is a lack of understanding in definition of the border between implantation metastases and multiple primary tumors in upper tract urothelial carcinoma and bladder cancer, between metastatic or bilateral tumors in bilateral renal cell carcinoma of the same morphology, etc.

Identification of BRAF, CCND1, and MYC mutations in a patient with multiple primary malignant tumors: a case report and review of the literature

BackgroundMultiple primary malignant tumors (MPMTs), usually associated with worse malignant behavior and prognosis comparing to a single primary tumor, and have recently been found to have an increasing incidence globally. However, the pathogenesis of MPMTs remains to be clarified. Here, we report a unique case of the coexistence of malignant melanoma (MM), papillary thyroid carcinoma (PTC), and clear-cell renal cell carcinoma (ccRCC) along with our perceptions on its pathogenesis.Case presentationThe case reported is of a 59-year-old male patient with unilateral nasal obstruction as well as a renal occupying lesion. Positron emission tomography-computed tomography (PET-CT) revealed a palpable mass of 32 × 30 mm on the posterior and left walls of the nasopharynx. In addition, an isodense nodule was observed in the right superior renal pole, approximately 25 mm in diameter, as well as a slightly hypodense shadow in the right leaf of the thyroid, approximately 13 mm in diameter. Nasal endoscopy and magnetic resonance imaging (MRI) confirmed the existence of a nasopharyngeal neoplasm. Afterward, biopsies of the nasopharyngeal neoplasm, thyroid gland and kidney were performed, and the patient was diagnosed with MM, PTC, and ccRCC according to the pathological and immunohistochemical results. Moreover, mutation of BRAFV600E was detected in bilateral thyroid tissues, and amplification of both CCND1 and MYC oncogenes were detected in the nasopharyngeal melanoma. After chemotherapy, the patient is now in good overall condition.ConclusionsThis is the first reported case of a patient with the co-existence of MM, PTC and ccRCC undergoing chemotherapy with a favorable prognosis. Herein, we suggest that such a combination may be non-random, as for mutation of BRAFV600E might account for the co-occurrence of PTC and MM, while mutations of CCND1 and MYC cause the coexistence of MM and ccRCC. This finding may provide valuable guidance on the diagnosis and treatment of such disease, as well as the prevention of developing a second or third tumor for patients with a single primary.

Effect made by the growth of multiple primary malignant tumors on the hypothalamicpituitary-gonadal axis in BALB/c Nude mice of both sexes

The aim was to study changes in the functioning of the hypothalamic-pituitary-gonadal (HPG) axis in BALB/c Nude mice of both sexes with multiple primary malignant tumors (MPMTs). The BALB/c Nude mice (n=84) of both sexes were divided into groups as follows: intact males and females (n=14), a reference group of mice of both sexes with standard subcutaneous inoculation of B16/F10 melanoma (n=14); the main group of mice with the reproduction of the MPMT model (n=14); B16/ F10 melanoma and Lewis carcinoma were inoculated into mice sequentially subcutaneously on two sides: one on the left side and the other on the right side. After 15 days of the growth of the malignant tumors, GnRH, LH and FSH contents were determined by ELISA using standard kits in 1% of the homogenates of the hypothalamic and pituitary tissues, and estradiol content (E2) was determined in 10% homogenates of ovaries and testes, as well concentrations of testosterone (T) and progesterone (P4) were identified in blood serum with the standard RIA kits (Immunotech, Czech Republic). Results. In the hypothalamus in females of the reference and main groups, the level of GnRH increased by 2.5-4 times, and in males it decreased by an average of 3.1 times; in response to those changes in animals of both sexes in the reference group and in the main group only in females in the pituitary gland the level of LH increased by 1.3-1.6 times, however a decrease in FSH in all groups was more pronounced in females: by 7.8-13.7 times and less pronounced in males: by 1.4-1.7 times (р˂0, 05). In the gonads of females, the level of E2 increased, but the levels of T and P4 decreased, while P4 increased in males. Blood parameters did not reflect hormonal changes in the organs. Conclusion. Abnormalities in the HHG axis performance, along with primary immunodeficiency, play a decisive role in overcoming antitumor protection for uncharacteristic malignant tumors.

Genetic Analysis of Multiple Primary Malignant Tumors in Women with Breast and Ovarian Cancer.

Familial cancer syndromes, which are commonly caused by germline mutations in oncogenes and tumor suppressor genes, are generally considered to be the cause of primary multiple malignant neoplasias (PMMNs). Using targeted genomic sequencing, we screened for eight germline mutations: BRCA1 185delAG, BRCA1 T300G, BRCA1 2080delA, BRCA1 4153delA, BRCA1 5382insC, BRCA2 6174delT, CHEK2 1100delC, and BLM C1642T, which provoke the majority of cases of hereditary breast and ovary cancer syndrome (HBOC), in genomic (blood) DNA from 60 women with PMMNs, including breast (BC) and/or ovarian cancer(s) (OC). Pathogenic allelic forms were discovered in nine samples: in seven instances, it was BRCA1 5382insC, and in the following two, BRCA1 4153delA and BRCA1 T300G. The age of onset in these patients (46.8 years) was younger than in the general Russian population (61.0) for BC but was not for OC: 58.3 and 59.4, correspondingly. There were invasive breast carcinomas of no special type and invasive serous ovarian carcinomas in all cases. Two or more tumors of HBOC-spectrum were only in five out of nine families of mutation carriers. Nevertheless, every mutation carrier has relatives who have developed malignant tumors.

Multiple primary malignant tumours of lung and colorectal adenocarcinoma: A case report

Multiple primary malignant tumors of lung and colorectal incidence were extremely rare and in most cases, diagnosed incidentally. Due to its rarity, most physicians consider pulmonary lesions found in patients with a history of colorectal cancer as lung metastasis. To avoid misdiagnosis and treatment delays, it is critical to properly screen and explore for possible metastasis or the occurrence of a second primary tumor after a primary cancer has been diagnosed. We describe a 72-year-old woman who presented with rectal bleeding associated with altered bowel movement. Rectal biopsy revealed colon adenocarcinoma and subsequent CT scan showed sigmoid colon mass and right lower lobe lung mass with multiple mediastinal lymphadenopathies. Biopsies of the mediastinal lymph nodes also showed adenocarcinoma. PET/CT scans showed different SUVmax of lesions in the sigmoid colon and right lower lobe, which raised the possibility of separate colonic and lung primary tumors as opposed to colonic primary with lung metastasis. Further immunohistology studies confirmed separate primary lung tumor. These diagnoses facilitate the clinical approach and define treatment options for the patient.

Abstract P1-09-08: Comparisons of aesthetic outcomes and prognosis of conventional breast conserving surgery, oncoplastic breast conserving surgery and breast conserving surgery plus immediate lipofilling in early breast cancer

Abstract Background: Conventional breast conserving surgery (CBCS) considered as a confined alternative to mastectomy could lead to potentially breast deformities. Oncoplastic breast conserving surgery (OBCS) as well as breast conserving surgery (BCS) plus immediate lipofilling have been shown to be reliable techniques for maintaining the natural breast contours, however, few studies compared those three surgical options for oncological safety, complications and aesthetic outcomes in early breast cancer (EBC). Methods: We retrospectively reviewed the data of BC patients who underwent BCS between January 2017 and December 2021 from The First Affiliated Hospital of Chongqing Medical University. We included female patients who received BCS for unilateral stage 0-III BC. Those who had bilateral BC, incomplete surgical records, unfinished adjuvant therapy, multiple primary malignant tumors and lost to follow-up and were excluded. Patient-reported outcome measures (PROMs) were assessed using the BREAST-Q Version 2.0. We utilized a multivariable linear regression model to identify clinical factors correlated with the BREAST-Q score, and the log-rank test and Cox regression models were used to compare the survival difference between groups. Results: Of 268 patients, 90 (33.6%) underwent CBCS, 53 (19.8%) underwent OBCS and 125 (46.6%) underwent BCS plus immediate lipofilling. Patients in OBCS and BCS plus immediate lipofilling groups were younger than those in CBCS group (mean age: 43.9yrs vs 49.1yrs, P=0.001 and 45.7yrs vs 49.1yrs, P=0.008). The largest tumor size and heaviest BCS specimen were observed in the OBCS group compared with CBCS (mean tumor size: 23.4mm vs 17.3mm, P< 0.001 and median excised weight: 122.0g vs 36.5g, P< 0.001) and BCS plus immediate lipofilling group (mean tumor size: 23.4mm vs 17.4mm, P< 0.001 and median excised weight: 122.0g vs 37.0g, P< 0.001). It was balanced for pathological type, Ki-67, ER and PR expression between three groups. In the multivariable linear regression models, with the CBCS group as referent, either OBCS or BCS plus immediate lipofilling groups had a significantly higher score in satisfaction with breast (Estimate: 9.27, P=0.001 and Estimate: 13.08, P< 0.001) and psychosocial well-being (Estimate: 6.06, P=0.021 and Estimate: 9.34, P< 0.001). Additionally, sexual well-being was improved among patients receiving BCS plus immediate lipofilling (Estimate: 6.19, P=0.029). Nevertheless, patients in OBCS group harbored worse physical well-being compared with CBCS (Estimate: -15.89, P< 0.001). There was no significantly statistical difference among three groups on re-excision rate (P=0.721) and postoperative complications (P=0.663). After 37-month median follow-up, identical event-free survival (EFS) was revealed among three groups (HROBCS vs CBCS: 3.93; 95%CI, 0.78-19.81, P=0.098; HRBCS plus Lipofilling vs CBCS: 1.15, 95%CI, 0.28-4.67, P=0.847). Conclusion: This study demonstrated that OBCS as well as BCS plus immediate lipofilling shared equivalent oncological safety but better cosmetic outcomes and patient satisfaction when compared with CBCS for EBC patients, suggesting that further prospective randomized clinical trials are warranted to confirm our findings. Citation Format: JH Ren, Yuanyuan Wang, Xiang Zhang, Kang Wang, Renxi Tang, Ling Yang, Junge Gong, Jiawei Xu, Qing Li, WM Zhu, Qiao Cheng, Guosheng Ren, Hongyuan Li. Comparisons of aesthetic outcomes and prognosis of conventional breast conserving surgery, oncoplastic breast conserving surgery and breast conserving surgery plus immediate lipofilling in early breast cancer [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P1-09-08.

Experience in the treatment of radioinduced angiosarcoma of the breast in a patient with primary multiple lesions of the breast and bladder. Case report

Among the multiple primary malignant tumors, breast cancer is the most common and in most cases it is combined with the second mammary gland, uterine body, stomach, colon, skin and ovary. Breast angiosarcoma is a very rare disease with unfavorable prognosis. Radiation therapy to the area of the breast is considered to be the main risk factor for the radiation-induced angiosarcoma. Diagnosis is based on the clinical aspect, the results of morphological and immunohistochemical findings. There are no uniform standards for the treatment of this pathology; a surgical method, systemic therapy, and radiation therapy are used. The article presents a clinical case of a female patient born in 1952, who was diagnosed with synchronous multiple primary cancer in 2014: stage 2A left breast cancer (cT2N0M0); bladder cancer stage I (cT1cN0M0). After the complex treatment, the patient received adjuvant endocrine therapy with Tamoxifen. In December 2018, single bluish formations appeared in the area of the postoperative scar, followed by a rapid growth of formations on the skin within a month, with a tendency to merge and necrosis. The patient was sent for biopsy of the formations with suspected recurrence of the disease. Immunomorphological patterns correspond to the angiosarcoma in the skin of the mammary gland. A simple mastectomy was performed. After 3 months, growth of angiomyosarcoma in the soft tissues of the anterior chest wall continued. Excision of the tumor in the soft tissues of the chest was performed and the patient underwent postoperative course of radiation therapy with a single focal dose (SFD) 2.5 Gy, total boost isodose of 50 Gy. At follow-up examinations held from January to December 2021, there is no evidence for continued growth and recurrence of the disease. The presented clinical observation demonstrates the experience of diagnostics and treatment of radiation-induced angiosarcoma in the patient with multiple primary synchronous lesions of the breast and bladder.

High incidence combination of multiple primary malignant tumors of the digestive system.

Clinical reports of multiple primary malignant tumors (MPMTs) in the digestive system are increasing. In China, although the survival rate of patients with MPMTs is increasing, the quality of life is very low. Many patients have reached the advanced stage when the second primary tumor is found, resulting in no early intervention and treatment. This is due to the misunderstanding of MPMTs by clinicians, who treat such tumors as metastases. Therefore, before a patient has a second primary tumor, doctors should understand some common combinations of digestive system MPMTs to provide clinical guidance to the patient. To explore the high incidence combination of digestive system MPMTs under heterochronism and synchronization. A total of 1902 patients with MPMTs at Peking Union Medical College Hospital were analyzed retrospectively. They were divided into metachronous MPMT and synchronous MPMT groups, and then the high incidence combinations of the first primary cancer and the second primary cancer in metachronous cancer and synchronous cancer were sorted. Sex and age differences between metachronous and synchronous tumors were tested by the chi square test and t test, respectively. A P value < 0.05 was considered as statistically significant, and SPSS version 26.0 (SPSS Inc., Chicago, Illinois, United States) was used for statistical analysis. Among the 1902 patients with MPMTs confirmed by pathology, 1811 (95.2%) cases were secondary primary cancers, 89 (4.7%) cases were tertiary primary cancers, and 2 (0.1%) cases were quaternary primary cancers. Most (88.2%) of the secondary primary cancers were identified as metachronous multiple primary cancers six months after diagnosis of the first primary cancer. The top ten most common MPMTs in the first primary cancer group ranged from high to low as follows: Breast cancer, thyroid cancer, nonuterine cancer, lung cancer, colon cancer, kidney cancer, uterine cancer, bladder cancer, rectal cancer, and gastric cancer. The highest incidence rate of the first primary cancer in male metachronous cancer was lung cancer (11.6%), the highest incidence rate of the second primary cancer was still lung cancer (24.9%), the highest incidence rate of the first primary cancer in female metachronous cancer was breast cancer (32.7%), and the highest incidence rate of the second primary cancer was lung cancer (20.8%). Among them, breast cancer, nonuterine cancer and uterine cancer were female-specific malignant tumor types, and thyroid cancer also accounted for 79.6% of female patients. The top five metachronous cancer combinations, independent of female-specific malignant tumor types and thyroid cancer, were colon cancer and lung cancer (26 cases), kidney cancer and lung cancer (25 cases), rectal cancer and lung cancer (20 cases), gastric cancer and lung cancer (17 cases), and bladder cancer and lung cancer (17 cases). The most common synchronous cancer combination was colon cancer and rectal cancer (15 cases). Screening for lung cancer should be performed six months after the detection of colon cancer while rectal cancer screening should be performed within six months.

Validation of the Role of Postoperative Radiotherapy in Improving Disease-Free Survival of Patients with Stage III ypN2 Non-Small Cell Lung Cancer after Neoadjuvant Therapy Followed by Complete Resection – A Propensity-Score Matching Study

<h3>Purpose/Objective(s)</h3> Although the Lung ART study, a phase III trial, showed that postoperative radiotherapy (PORT) could not significantly improve the disease-free survival (DFS) of patients with pN2 non-small cell lung cancer (NSCLC) after complete resection. However, its subgroup analysis showed that PORT did significantly improve the DFS of those with ypN2 NSCLC after neoadjuvant therapy and surgery. Our study aimed to validate the effect of PORT on the survival of patients with ypN2 NSCLC. <h3>Materials/Methods</h3> Patients was filtrated from our center from 2004 to 2021. The inclusion criteria of patients were as follows: 1) diagnosed with NSCLC; 2) accepted neoadjuvant systematic treatments including chemotherapy, tyrosine kinase inhibitors (EGFR, ALK), or immune checkpoint inhibitors; 3) received complete resection (R0 resection); 4) with stage III ypN2 disease (AJCC 8^th). We excluded patients with multiple primary malignant tumors and those who died within four months after surgery. The primary endpoint was DFS. The second endpoints were overall survival (OS) and locoregional recurrence-free survival (LRFS). Propensity-score matching (PSM) was used to match the baseline characteristics between the PORT group and the non-PORT group. Kaplan-Meier method was used to estimate the endpoints. All data were analyzed using R 4.1.2. <h3>Results</h3> Totally 185 patients were included in the final analysis. There were 49 patients (26.5%) with PORT. After 1:1 PSM between the PORT group and the non-PORT group, 82 patients remained with 41 in each group. The baseline characteristics of majority in the matched cohort were as follows: male (75.6%), smoking history (79.3%), performances scores 0-1 (100%), adenocarcinoma (47.6%), grade 3-4 (58.5%), receiving neoadjuvant chemotherapy (91.5%), lobectomy (82.9%), ypT1-2 (78.9%), and ypN2b (51.2%). The median age of patients was 58. The median numbers of examined and positive lymph nodes were 20.5 and 6. The median follow-up time was 49.5 months. The median DFS of the PORT group and the non-PORT group were 25.5 months vs. 18.6 months, with the 5-year DFS rates of 43.4% vs. 24.8%, respectively (P=0.044). The median LRFS of the two groups were not reached vs. 56.8 months, with the 5-year LRFS rates of 89.1% vs. 39.8% (P<0.001). The median OS of the two groups were not reached vs. 67.7 months, with the 5-year OS rates of 76.7% vs. 34.8% (P=0.092). <h3>Conclusion</h3> For patients with stage III ypN2 NSCLC after neoadjuvant systematic therapy followed by complete resection, PORT can significantly improve the DFS and LRFS, but failed to improve OS. However, the results need to be clarified by prospective randomized clinical trials.

A single centre study from western India to evaluate the frequency of developing second and subsequent multiple primary malignancies among cancer survivors

AimThis study was designed to evaluate the frequency of developing second and subsequent primary cancers among cancer survivors.MethodsWe have retrospectively analyzed 121 multiple primary cancer patients treated at Bhagwan Mahavir Cancer Hospital and Research Centre, Jaipur, Rajasthan, India from the last 20 years. The survival analysis was performed by Kaplan-Meier methodology.ResultsThe prevalence of multiple primary malignant tumors (MPMTs) was 1.51% (121/8000), with a male to female ratio of 1:1.42. In males most of the reported MPMTs were synchronous and most common first primary cancer cases were head & neck and lung whereas, in females most of the reported MPMTs were metachronous and most common first primary cancer cases were breast and gynaecological malignancies. Family history was reported in 15 cases. Maximum 33.05% patients received combined treatment of chemotherapy, radiotherapy and 91.73% (111/121) of patients with MPMTs were effectively followed up, 35 (28.92%) patients died and 5-year survival rate of the remaining 86 patients was 68.46%.ConclusionsIn the present observational study the most frequent sites of MPMTs in men were head & neck and lung whereas, in women breast and gynaecological sites were common. Therefore, careful monitoring and follow up are required for these patients.

Management of patients with multiple primary сancer in the practice of a modern oncologist. Case report and literature review

The purpose of the study. Multiple primary malignant neoplasms or polyneoplasia are a phenomenon of tumorigenesis and one of the little-studied categories in modern clinical oncology. The increase in the cancer incidence, as well as the need to make difficult decisions about further treatment strategy, enhance the relevance of studying multiple primary malignant neoplasms. This review discusses the current positions of medicine in relation to this category of malignant neoplasms, and presents a case report of a patient with this disaese. Material and methods. We have analyzed the results of international studies on the management of patients with multiple primary cancer. the search for relevant sources was carried out in the Web of Science, Scopus, Medline systems with a chronological interval of 2016–2021. of the analyzed studies, 60 were used to compile a systematic review with a case report. Results. The analysis showed that timely diagnosis and improvement of cancer screening programs are necessary to improve the control of these tumors. Psychological work with a patient, strengthening of his commitment to therapy and the implementation of medical recommendations are integral parts of improving cancer care for patients with such disease. Conclusion. A comprehensive analysis of multiple primary malignant tumors requires long-term follow-up of a large population, taking into account genetic factors, environmental factors, exposure to smoking and nutrition, and comorbid pathology. Timely diagnosis and improvement of cancer screening programs are necessary to improve the control of multiple primary malignant tumors.

Synchronous multiple primary tumors in patients with malignant lymphoma: a retrospective study

BackgroundSynchronous multiple primary malignant tumors (sMPMTs) are sometimes diagnosed in patients with malignant lymphoma. We herein investigated the prognostic impact of sMPMT in lymphoma patients and the optimal treatment strategy.MethodsSeventy-five patients with sMPMTs (5.8%) among 1285 patients with lymphoma newly diagnosed between August 2004 and April 2020 were enrolled.ResultsIn patients with indolent lymphoma, those with sMPMTs had a worse prognosis than those without sMPMTs (5-year overall survival [OS]: 73.4% and 87.8%, respectively; P = 0.047). Among those with high and low tumor burden, the cumulative rate of death due to solid tumors was significantly higher in patients with sMPMTs than those without sMPMTs (high tumor burden: 26.7% vs. 1.6%, P < 0.001; low tumor burden: 12.7% vs. 1.0%, P = 0.003). The presence of sMPMTs did not have a significant impact on outcomes in patients with diffuse large B-cell lymphoma (DLBCL) (5-year OS: 65.4% and 66.9%, respectively; P = 0.74; 5-year progression-free survival [PFS]: 65.5% and 59.9%, respectively; P = 0.65). However, the cumulative rate of death from solid tumor in patients with sMPMTs was significantly higher than in patients without sMPMTs (5-year cumulative rate: 7.4% and 2.1%, respectively; P = 0.004). The treatment sequence did not have a significant effect on outcomes or the relative dose intensity of chemotherapy.ConclusionsIn patients with indolent lymphoma, those with sMPMTs had a significantly worse prognosis than those without sMPMTs, mainly because of high mortality due to solid tumors. The presence of sMPMTs was not a significant prognostic factor in patients with DLBCL. It is important to assess the status and need for early treatment of each type of malignancy in patients with sMPMTs.