Multiple Primary Tumors Research Articles

Synchronous Primary Tumors of Kidney and Bilateral Ovaries-A Diagnostic Challenge: Case Report

Multiple malignancies in the same patient account for 2% to 17% of all cancers. However, multiple synchronous primary tumours in the same patient are extremely rare. Most synchronous primary tumors involve the genitourinary and gastrointestinal tract, followed by both breast and genitourinary tract, and breast and gastrointestinal tract. Among gynaecological malignancies, synchronous primary carcinomas of the endometrium and ovary are the commonest. Synchronous primary neoplasm involving kidney and ovaries are extremely rare, with only few case reports in the literature; however, there are no reported cases in the Indian literature. We hereby report a case of 60 year old woman who underwent radical nephrectomy for renal cancer and primary cytoreductive surgery for her ovarian cancer. In this report we present the first case in the Indian literature of synchronous primary cancers in right kidney and bilateral ovaries. Based on the combination of factors (diagnosis, treatment and demographics), it is expected that in the course of the coming years, the prevalence of patients with multiple primaries will increase. Careful attention should be paid to the differential diagnosis between double primary and metastatic tumours, based on the pathologic, radiological and clinical characteristics.

Inherited syndromes involving pancreatic neuroendocrine tumors.

Inherited syndromes are important to recognize in the setting of a pancreatic neuroendocrine tumor (PNET) as there are significant implications for the patient's medical management and opportunity for early detection of subsequent manifestations. Although most PNETs are sporadic, approximately 10% are due to an inherited syndrome, which include multiple endocrine neoplasia type 1 (MEN1), multiple endocrine neoplasia type 4 (MEN4), von Hippel-Lindau disease (VHL), neurofibromatosis type 1 (NF1), and tuberous sclerosis complex (TSC). The general hallmarks of a hereditary endocrine neoplasia predisposition syndrome include any one of the following: multiple primary tumors (in the same or different organs), rare tumors (prevalence of less than 1 in 1,000 people in the general population), earlier age of diagnosis (usually under the age of 40), characteristic pattern of disease in the individual or family (phenotype and inheritance pattern). These syndromes are monogenic (due to a single gene disorder), highly penetrant (with all carriers of the disease exhibiting at least part of the phenotype) and can display variable expressivity (where affected individuals may have different presentations and features of the disease). A thoughtful approach to management is required, even if the presenting symptom is resolved, as these syndromes often involve multi-organ disease with a lifelong risk for tumor development. Additionally, the natural history of tumors in the setting of a hereditary condition may be different than would be expected in a sporadic form of the disease. For example, in some circumstances the risk of metastatic disease is lower, and therefor longer observation is the preferred approach over early surgical intervention. The unique aspects to management, challenges in hereditary disease recognition and accurate diagnosis, and rarity of these syndromes are all reasons to support referral to high-volume centers with the experience and knowledge to treat patients with hereditary endocrine neoplasia syndromes.

Characterization of patients with multiple primary tumors.

1502 Background: 17% of patients (pts) with a cancer diagnosis in the U.S. have a prior malignancy. We sought to characterize pts with multiple (≥2) primary cancers (MPC) & identify potential drivers of cancer risk to guide management. Methods: Pts prospectively consented (1/2013-2/2019) to tumor-normal sequencing via custom targeted NGS panel. A subset consented to testing of >76 germline cancer predisposition genes. IARC 2004 rules for defining MPC were applied.Age adjusted gender specific standardized incidence ratios (SIR) for cancer event combinations occurring in at least 5pt were calculated using R statistical package. Results: Of 24417 pts sequenced, 4341 had MPC (18%). (Table) 3465 (80%) had 2, 4% had >4 cancers. Cancer pairs where SIR of 2nd cancer was higher than expected included: colon-colon, prostate-pancreas, bladder-prostate in men & lung-lung, breast-pancreas, thyroid-pancreas in women. 1580 (36%) pts had germline testing; 324 (21%) had 361 pathogenic/likely pathogenic (P/LP) variants (vts). Of these, 157 (48%), 66(20%), pts had high, moderate penetrance vts. The remainder had low penetrance, recessive or vts of uncertain utility. Of pts with high penetrance vt, 132 (84%) had at least one tumor type concordant with germline findings. Conclusions: 18% of pts in this cohort had MPC. There was a significant excess over expected incidence in some cancer combinations. Of pts with germline testing, 21% had a P/LP vt, with most (69%) being high or moderate penetrance. Assessment for loss of heterozygosity in tumor & germline sequencing of the full MPC cohort is ongoing. [Table: see text]

Characterizing patients with breast cancer who seek second opinions at an academic cancer center.

e19229 Background: Although second-opinion (SO) seeking is common in the field of oncology, there is limited empirical research on its drivers and consequences. This study’s objective is to compare the demographic and tumor characteristics between patients with newly diagnosed breast cancer who seek out SOs for treatment planning purposes with those who do not. Methods: This retrospective study includes women with newly diagnosed breast cancer who attended a single academic cancer center between 2017 and 2018 for an initial treatment consultation. Data elements were extracted from the medical record. Characteristics of first opinion and SO seekers were compared using descriptive statistics and chi-square testing. Multivariate logistic regression was used to identify predictors of SO seeking. Odds ratios (ORs) and their 95% confidence intervals (CIs) were estimated. Results: Of the 547 newly diagnosed patients, 147 (26.8%) were SO seekers. Compared to those seeking a first opinion, SO seekers were statistically significantly more likely to be younger and White and to have multiple primary (versus single) tumors, and have more advanced stage (II-IV) tumors. The two groups did not differ in terms of marital status, insurance, tumor grade, and tumor hormone receptor status. In the multivariate analysis, age, race/ethnicity, and tumor stage remained statistically significant. Compared to those age 65 and older, those age <54 (OR=2.28; 95% CI:1.38-3.79) and those age 55-64 (OR=1.83; 95% CI:1.10-3.06) had a higher odds of seeking a SO. Compared to White women, Black (OR=0.33; 95% CI:0.18-0.63) and Hispanic women (OR=0.51; 95% CI:0.25-1.05) had a lower odds of SO seeking. Women with advanced stage tumors (OR=1.86; 95% CI:1.22-2.86) had a higher odds of seeking a SO compared to those with earlier stage tumors. Additionally, SO seekers had higher odds of multiple primary tumors (OR=1.63; 95% CI:0.99-2.69). Conclusions: In this study, SOs for breast cancer care were relatively common. SO seekers were more likely to be younger, White, and to have more advanced disease stage. Further analyses will include investigating the role of psychosocial factors in SO seeking and treatment changes resulting from SOs. More research on the value of SOs is needed to help guide patients and providers.

Simultaneous Stereotactic Radiofrequency Ablation of Multiple (≥ 4) Liver Tumors: Feasibility, Safety, and Efficacy

PurposeTo assess feasibility, safety, and clinical outcome of simultaneous stereotactic radiofrequency (RF) ablation of multiple (≥ 4) primary and metastatic liver tumors. Materials and MethodsThis retrospective observational study included 92 patients (29 women, 62 men), 35 with ≥ 4 hepatocellular carcinomas (HCCs) and 57 with ≥ 4 metastatic liver tumors at initial stereotactic RF ablation between 2005 and 2018. The median size of 178 HCCs and 371 metastases was 2.2 cm (range, 1.0–8.5 cm) and 3.0 cm (range, 0.5–13 cm), respectively. At initial stereotactic RF ablation, 17 (48.6%) patients with HCC and 19 (33.3%) with metastases had 4 liver tumors, 11 (31.4%) and 19 (33.3%) had 5 tumors, and 7 (20%) and 19 (33.3%) had ≥ 6 tumors. ResultsMajor complications occurred in 2 of 35 ablations (5.4%) in patients with HCCs and in 7 of 63 (10%) with metastases. The primary technical efficacy rate (ie, successful initial ablation) was 100% (178/178) in HCCs and 98.8% (363/371) in metastases. Local recurrence was observed in 4 of 178 (2.2%) HCCs and in 17 of 371 (4.6%) metastases. Overall survival (OS) rates at 1, 3, and 5 years from the date of the first stereotactic RF ablation were 88.0%, 54.0%, and 30.4% for patients with HCCs with a median OS of 38.2 months and 86.1%, 53.1%, and 37.3% for patients with metastases with a median OS of 37.4 months. ConclusionsStereotactic RF ablation is a feasible, safe, and efficacious option in simultaneous management of multiple primary and metastatic liver tumors.

THE TREATENT OF PRIMARY MULTIPLE CANCER IN A PATIENT WITH A KIDNEY GRAFT. CLINICAL INCIDENCE

Treatment of tumors in kidney recipients is not an easy task, due to lifelong immunosuppression. The leading place among all graft tumors is skin cancer - 31%, and the 3rd place is occupied by tumors of the genitourinary system (0.35.8%). The main method of treating skin cancer is surgical, which is difficult to perform in some localities. An alternative method is radiation therapy. The tumor in the graft is rare. The method of treating a tumor of this localization is surgical, which can lead to nephrectomy of the graft. Radiofrequency-assisted graft resection is an original treatment method. Its use provides good immediate and long-term treatment results. Patient B., born in 1977, 20.10.2016 was diagnosed with a tumor in kidney graft T1aN0M0 (stage I). Allotransplantation of the kidney to the left iliac vessels from 15.01.2012. When choosing the method, there were difficulties: an obese patient, graft eventration in anamnesis, according to MSCT, intestinal loops are located around the kidney graft, and fibrous changes around the kidney graft. Laparoscopic radiofrequency - assisted renal graft resection was chosen as the method of treatment. Operation duration-120 minutes, blood loss-100 ml. The postoperative period was uneventful. Currently, there are no signs of relapse. In June 2019-the appearance of a skin formation in the area of the left auricle, histologically-squamous cell cancer, G III. From 12.07.2019-short-focus radiation therapy with ROD 3 G, SOD 54 G. The treatment was carried out satisfactorily. In October 2019-a similar formation on the skin of the left cheek. From 14.11.2019-short-focus radiation therapy, ROD 2.75 G, SOD 55 G. The treatment was carried out satisfactorily. Currently, there are no signs of a recurrence of the tumor. The use of modern techniques and equipment makes it possible to perform treatment of primary multiple tumors in patients after kidney transplants with satisfactory cosmetic, functional and oncological results.

Polyneoplasia associated with gastrointestinal stromal tumor: literature review and case report

The purpose of the study was to demonstrate a rare clinical case of polyneoplasia associated with GIST, combining three malignant neoplasms of different nosological affiliation and different tissue origin. Scientific interest is caused by the need to study polyneoplasia associated with Gist, which can be explained by the concept of Rodriquenz M.G. et al. (2016), suggesting the special role of a solitary GisT in the potential development of polyneoplasia. Material and Methods . The search for relevant sources was carried out in the Medline, Cochrane Library, Elibrary systems, includibg publications from January 2009 to October 2019. Of the 507 studies, 21 were used to write a systematic review. Results. In the vast majority of cases, polyneoplasia is represented by two malignant neoplasms in a single patient. Primary multiple metachronous and primary multiple synchronous tumors with three or more tumors are observed very rarely. Among all multiple primary tumors, our attention was drawn to polyneoplasia containing GisT. A neoplasm associated with a GisT is localized mainly in the gastrointestinal tract, and also occurs in the organs of the urinary system, female genital system, thyroid gland, breast, lungs, and testicles. Conclusion. This clinical case is a rather rare phenomenon of polyneoplasia associated with GisT of rectum, which combines three malignant neoplasms. It should be noted that primary Gist in the rectum occurs in 4% of cases.

Short-term efficacy of robotic-assisted total mesorectal excision with and without lateral lymph node dissection for mid-low advanced rectal cancer: a propensity score matching analysis

Objective: To evaluate the feasibility, safety and efficacy of robotic-assisted lateral lymph node dissection for mid-low advanced rectal cancer. Methods: A retrospective cohort study was performed. Inclusion criteria: (1) age between 18 and 80 years old; (2) rectal adenocarcinoma diagnosed by pathology; (3) without distant metastasis by preoperative CT or MRI; (4) patients underwent robotic-assisted total mesorectal resection (TME). Exclusion criteria: (1) conversion to open surgery; (2) multiple primary tumors; (3) patients underwent combined multiple organ resection. According to the above criteria, 137 patients undergoing robotic-assisted mid-low rectal cancer resection in the First Affiliated Hospital of Xi'an Jiaotong University from December 2016 to April 2019 were enrolled. Ninety-seven cases underwent robotic-assisted total mesorectal excision (TME group) and 40 underwent robotic-assisted total mesorectal resection with lateral lymph node dissection (LLND) (TME+LLND group, pelvic LLND was performed with neurovascular guidance to retain pelvic autonomic nerves in the order of the left side the first and then the right side). The propensity score matching of 1:1 was performed with R software, based on age, sex, BMI, ASA classification, distance from tumor to the anal verge, preoperative chemoradiotherapy history, preoperative abdominal surgery history, the size of tumors and TNM stage. The operative indicators, postoperative recovery, pathology and postoperative complications within 30 days were compared between the two groups. Results: A total of 72 cases were successfully matched (36 in each group), and there were no statistically significant differences in baseline data between the two groups (all P>0.05). The operation time of TME+LLND group was significantly longer than that of TME group [275.0 (180-405) minutes vs. 220.0 (140-320) minutes, Z=-3.680, P<0.001], while there were no statistically significant differences in blood loss during operation, time to postoperative first flatus, postoperative hospital stay, total hospital cost, tumor differentiation, and distal resection length of margin (all P>0.05). Circumferential resection margin was all negative in both groups. The number of harvested lymph modes in the TME+LLND groups was higher than that in the TME group [26 (18-37) vs. 14 (9-36), Z=-6.407, P<0.001]. In addition, there were no statistically significant differences in postoperative morbidity and Clavien-Dindo classification of complication within 30 days between the two groups (both P>0.05). Conclusions: Although robotic lateral lymph node dissection requires longer operation time, it is a feasible, safe and effective procedure.

The Synchronous Presence of Multiple Myelomas and Other Primary Malignant Tumors: Case Series with Literature Review.

ObjectiveThe synchronous presence of multiple myeloma (MM) and other primary malignant tumors (PMTs) were rarely reported. This study aimed to analyze several cases of MM and other PMTs in order to improve clinicians’ understanding of multiple myeloma (MM) with sMPMTs.MethodsThis study was a retrospective trial. We retrospectively analyzed six cases of the synchronous presence of MM and other PMTs and reviewed the literature to summarize the clinical features and treatment.ResultsThe results showed that five cases of immunoglobulin G (IgG) and one case of kappa light chain; D-S stage: six case of stage III; ISS stage: one case of stage I, two cases of stage II, and three cases of stage III; one case each of gastric cancer (pT2N0MO, stage I), breast cancer (pT1bN0M0, stage I), lung cancer (pT1N0M0, stage I), cervical cancer (stage IB2), thyroid cancer (pT1N0M0, stage I), and diffuse large B-cell lymphoma (Ann-Arbor stage II); three of five patients underwent surgery alone, one patient underwent surgery first and then received chemotherapy at the time of pleural metastasis and the other patient only received radiotherapy; two patients were still alive, three died of progression of MM, and one died of lung cancer. The median survival time was 33.5 months (95% CI, 14.17 to 59.5months).ConclusionThe relationship between synchronous MM and other PMTs remains unknown. Clinicians should improve their understanding of MM with sMPMTs by carrying out multidisciplinary collaboration and a patient-oriented approach to optimize treatment and prolong the survival rates of patients.

ОПЫТ МУЛЬТИВИСЦЕРАЛЬНЫХ РЕЗЕКЦИЙ ПРИ МЕСТНОРАСПРОСТРАНЁННОМ И ПЕРВИЧНО-МНОЖЕСТВЕННОМ РАКЕ ПРЯМОЙ КИШКИ

Objective: Assessing short-term and long-term results of multivisceral resections (MVR) performed for rectal cancer (RC) with invasion into adjacent pelvic organs, as well as the effectiveness of bladder reconstruction with the formation of a urinary reservoir of «low» pressure. Methods: The work was based on the results of surgical treatment of 37 patients with locally advanced or primary multiple RC underwent MVR. Invasion of adjacent small organs was observed in 89.2%, primary multiple malignant tumors (PMMT) – in 10.8% of patients included in the study. Results: According to the preoperative examination of tumor infiltration of one adjacent organ was diagnosed in 20 (54.1%), two or more organs – in 17 (45.9%) observations; more often affected the bladder – in 18 (48.6%) cases. Volumes of performed operations: in 6 (16.2%) cases of complete pelvic organs evisceration, in 10 (27%) cases of MVR with rectal extirpation, in 21 (56.8%) cases of MVR with resection of the rectum and adjacent organs. More often in 27 (72.9%) patients, there was urinary tract resection, of which 11 (29.7%) patients underwent primary bladder repair with the formation of ortho- (n=3) or heterotopic (n=6) urinary reservoir of «low» pressure. Postoperative complications developed in 14 (37.8%) patients, what required re-surgery in 8 (21.6%) observed, of which urological complications occurred in 4 (10.8%) patients. Complications were not observed during the formation of the artificial bladder according to the presented method. Long-term results: RC – overall and disease-free 2-year survival – 78.1% and 65.6% respectively, PMMT – all patients are alive without signs of relapse, the timeline of observation is 24 months. Conclusions: The immediate results of MVR on locally advanced RC can be considered as satisfactory. The level of postoperative complications is primarily due to the prevalence of primary tumors. In case of urinary tract resection, primary plastic surgery is preferred. Long-term results allows to examine such operations as a method of choice in the treatment of RC with invasion in adjacent organs. Keywords: Rectal cancer, surgical treatment, multivisceral resection, bladder reconstruction, postoperative complications, disease-free survival.

Skin cancer multiplicity in lung transplant recipients: a prospective population-based study.

Lung transplant recipients are at high risk of skin cancer, but precise annual incidence rates of treated skin cancers per patient are unknown. To perform a prospective assessment of the total burden of histologically confirmed squamous cell carcinoma (SCC) and basal cell carcinoma (BCC) and associated factors in lung transplant recipients. A population-based cohort of 125 Queensland lung transplant recipients aged 18 years and over, recruited between 2013 and 2015, were followed to the end of 2016. All underwent dermatological skin examinations at baseline and annually thereafter and patients self-reported all interim treated skin cancers, which were verified against pathology databases. Standard skin cancer risk factors were obtained via questionnaire, and details of medications were acquired from hospital records. During a median follow-up time of 1·7 years, 29 (23%) and 30 (24%) lung transplant recipients with a median duration of immunosuppression of 3·3 years developed SCC and BCC, respectively. The general population age-standardized incidence rates of SCC and BCC were 201 and 171 per 1000 person-years, respectively (based on first primary SCC or BCC during follow-up); however, on accounting for multiple primary tumours, corresponding incidence rates were 447 and 281 per 1000 person-years. Risk of multiple SCCs increased around sixfold in those aged ≥ 60 years and in those with previous skin cancer, and increased around threefold in those treated with the antifungal medication voriconazole. Multiple BCC risk rose threefold from age 60 years and tenfold for patients with previous skin cancer. Lung transplant recipients have very high incidence of multiple primary skin cancers. Close surveillance and assiduous prevention measures are essential. Linked Comment:Proby and Harwood. Br J Dermatol 2020; 183:416-417.

Multiple primary prostate tumors with differential drug sensitivity.

342 Background: The differential aggressiveness of potentially independent prostate cancer clones remains largely unknown. Appropriate prostate cancer staging using mpMRI and biopsy tissue can be confounded by sampling error. To date, there has been no understanding of whether clonal variability influences management decisions for localized prostate tumors. We sought to identify the sensitivity and genomic profile of distinct localized tumors from a patient following systemic intense neoadjuvant androgen deprivation therapy (ADT). Methods: A 66-year-old man with high risk prostate cancer enrolled in a Phase 2 study of intense neoadjuvant ADT (goserelin + enzalutamide; inADT). Baseline mpMRI showed a single semi-contiguous lesion encompassing the right apical-mid PZ extending into the left distal apical PZ. MR/US-fusion targeted biopsy was performed before 6 months of inADT. A second mpMRI was performed before radical prostatectomy. Whole exome sequencing on microdissected tumor foci identified somatic mutations and copy number alterations, which were further used with immunohistochemistry to assess tumor clonal architecture and genomic/phenotypic evolution of treatment resistant tumor. Results: We found two clonally independent tumors exhibited intrinsic heterogeneity at baseline which correlated with response or resistance. Biopsies of distinct left- and right-sided tumors showed differing histologies. mpMRI and pathology showed near complete response of the left-sided tumor and substantial resistance of the right-sided tumor, which exhibited a large intraductal component. Histology and whole exome data highlighted a divergence in the status of PTEN and TP53, tumor suppressor genes implicated in prostate cancer progression. Conclusions: These data highlight that even nascent prostate cancer is heterogenous and neoadjuvant therapeutic strategies will need to consider this for clinical optimization. Evolutionary trajectories that resulted in tumor heterogeneity in this case likely contributed to our observation that two independent prostate tumor nodules with distinct genetic alterations responded differently to neoadjuvant intense ADT. Clinical trial information: NCT02430480.

A case report of multiple primary prostate tumors with differential drug sensitivity

Localized prostate cancers are genetically variable and frequently multifocal, comprising spatially distinct regions with multiple independently-evolving clones. To date there is no understanding of whether this variability can influence management decisions for patients with prostate tumors. Here, we present a single case from a clinical trial of neoadjuvant intense androgen deprivation therapy. A patient was diagnosed with a large semi-contiguous tumor by imaging, histologically composed of a large Gleason score 9 tumor with an adjacent Gleason score 7 nodule. DNA sequencing demonstrates these are two independent tumors, as only the Gleason 9 tumor harbors single-copy losses of PTEN and TP53. The PTEN/TP53-deficient tumor demonstrates treatment resistance, selecting for subclones with mutations to the remaining copies of PTEN and TP53, while the Gleason 7 PTEN-intact tumor is almost entirely ablated. These findings indicate that spatiogenetic variability is a major confounder for personalized treatment of patients with prostate cancer.

Clinical characteristics and survival outcomes of perianal Paget's disease: A SEER population-based study*

Abstract Objective The aim of the study was to analyze the clinical features of patients with perianal Paget's disease (PPD) and investigate prognosis risk factors. Methods The SEER*Stat software was used to identify 116 PPD patients from 1975 to 2015 in the SEER research database. The Kaplan-Meier method was used to conduct a univariate analysis for PPD patients. The differences in survival rates were evaluated using the log-rank test. The differences in the clinicopathological features of PPD patients with or without anorectal carcinoma were compared using the chi-square test. Results The median survival time of PPD patients was 44 months. The median age of onset was 73 years old. The 43.10% of the patients were alive at the end of follow up, and only 12.93% of the patients died of PPD. Elderly (age &gt; 70 years; χ2 = 9.453, P = 0.002), poor differentiation (χ2 = 46.557, P = 0.000) and abdominal perineal resection (APR; χ2 = 46.557, P = 0.000) were unfavorable risk factors of prognosis. Nearly 50% of PPD had combined with other malignancies, and over 22.41% of those had multiple primary neoplasms (3 or more). PPDs predisposed concurrent malignancy, and 48.21% of PPD patients with other malignancies combined with anorectal carcinoma in the study. Stage (χ2 = 10.127, P = 0.018), and surgical method (χ2 = 12.245, P = 0.007) were statistically significant in the PPD patients with or without anorectal carcinoma. The 16.07% of patients had multiple lesions of Paget's. Conclusion Patients with PPD have a favorable survival, while the disease-specific mortality is low. Diagnosed age, differentiation, and surgical methods were the influence factors of prognosis in PPD patients. PPDs with anorectal carcinoma is of most important in further investigation.

Clear cell renal carcinoma synchronous with dedifferentiated liposarcoma: a case report and review of the literature

BackgroundMultiple primary malignant neoplasms are not frequent but are increasing in incidence. Some of them are associated with genetic syndromes such as von Hippel-Lindau syndrome and Li-Fraumeni syndrome. Dedifferentiated liposarcoma is one of the rarest soft tissue tumors, and clear cell renal carcinoma is the most frequent kidney cancer. The concomitant presence of these tumors is extremely rare; however, some cases have been reported, none of them presenting with liposarcoma of the limbs. We report an interesting case of a patient with synchronous multiple primary tumors presenting with a very rare liposarcoma associated with renal cell carcinoma (a very rare association). A review of the literature and a collection of similar cases published previously are also provided.Case presentationWe report a case of a 62-year-old Hispanic man who presented to our institution with a left thigh mass compatible with dedifferentiated liposarcoma synchronous with metastatic clear cell renal carcinoma. Multiple treatment lines were provided with no response, with a further metastatic transformation. Genetic analysis by liquid biopsy showed some mutations that were not susceptible to targeted therapy. At the time of this report, the patient is undergoing palliative care because his nonresponsive metastatic disease persists.ConclusionsWe present the first reported case of clear cell renal carcinoma synchronous with dedifferentiated liposarcoma of a limb. The association between renal cell carcinoma and dedifferentiated liposarcoma is unusual, and there are few reports of this presentation in the literature. More research about these tumors along with genetic tests needs to be performed to seek a better understanding of the fundamental basis of this rare association.

Double extremes of brain tumors – Dilemma of decision-making and pitfalls of image: A case report and literature review

Coexistence of multiple primary intracranial tumors has been reported previously. However, most of simultaneous tumors occurred after intracranial radiotherapy or in high association with heredity. Both primary intracranial tumors arising simultaneously at synchronous discrete sites were introduced without prior radiation or genetic disorders. These tumors showed the same characteristic according to preoperative images. Two distinct tumors, meningioma and anaplastic oligoastrocytoma were revealed by postoperative histopathological findings. We present this unusual case to exhibit the rare possibility that two distinct primary brain tumors can occur in the same patient. Although magnetic resonance image were used to define the tumor patterns in almost cases, some diagnostic pitfalls may occur with coexistent primary brain tumors. Hence, a discrepancy between clinical impressions and radiological findings should raise a further survey for potential different natures. Reviewing the literature, we should remove the symptomatic tumors based on mass effect and presenting symptoms first, whether it is a benign-looking meningioma or a malignant astrocytoma. Surgical priority for two distinct synchronous tumors from each other needs individual evaluation carefully.

Genetic analysis of multiple primary cancers: A case report

Introduction. The occurrence of more than one primary cancer in the same patient is not very common. Multiple cancer prevalence is about 7.9% and the percentage is lower as the number of multiple primary cancers is higher. The incidence of four or more primary cancers in one patient is very rare and its prevalence is around 0.07%. Case Report. We report a rare case of a female with four histopathologically confirmed primary malignant neoplasms. The first tumor was endometrial carcinoma diagnosed at the age of 52. Three additional metachronous tumors were diagnosed as follows: left breast cancer, melanoma, and contralateral breast cancer. Extensive genetic testing was performed and 19 genes were sequenced using the next generation sequencing (BRCA1, BRCA2, ATM, BRIP1, CDH1, CHEK2, MSH2, MLH1, MSH6, PMS2, EPCAM, NBN, NF1, PALB2, PTEN, RAD51C, RAD51D, STK11 and TP53). Even with the existing indicators of genetic etiology, this case showed no pathogenic mutations in any of these genes. This indicates the existence of other underlying mechanisms such as hormonal factors, previous treatment of the primary and subsequent tumors, environmental factors, gene-gene and gene-environment interactions, as well as immunosuppression that could increase the risk for the second and subsequent malignancies. Conclusion. Detailed information on the biology of multiple primary tumors is important for both clinicians and cancer patients during medical management following primary treatment. In addition, genetic information is very important because it has future implications for both patients and their family members.

Stereotactic Radiation Therapy (SRT) for Brain Metastases of Multiple Primary Tumors: A Single Institution Retrospective Analysis.

Purpose: To evaluate the efficiency and side effects of stereotactic radiation therapy (SRT) with or without other treatments for brain metastases (BM) from various primary tumors.Methods: This was a retrospective analysis of 161 patients with brain metastases treated with SRT. Clinical data, EGFR mutation status and survival data were collected. Follow-up data was analyzed until December 2018. Kaplan-Meier and Cox proportional hazards regression analyses were used for the survival analysis.Results: The median overall survival (OS) was 19 months. No difference was observed in OS between SRT group and SRT + whole brain radiation therapy (WBRT) groups (p = 0.717). Statistically significant factors of better OS after univariable analysis were no extracranial metastases (p = 0.016), BED10-SRT≥50Gy (p = 0.049), oligometastases (1–3 brain metastases) (p < 0.001), GPA score≥2.5 (p = 0.003), RPA class I (p = 0.026), NSCLC tumor type (p = 0.006), targeted therapy (p < 0.001) and controlled extracranial disease (p = 0.011). Multivariate analysis indicated that higher BED10-SRT (≥50Gy, HR = 0.504, p = 0.027), controlled extracranial disease (HR = 0.658, p = 0.039) and targeted therapy (HR = 0.157, <0.001) were independent favorable predictors for OS. Besides that, we also find that the median overall survival (OS) was 22 months in NSCLC patients and controlled extracranial disease (HR = 0.512, p = 0.012) and targeted therapy (HR = 0.168, < 0.001) were independent favorable predictors for OS.Conclusion: For patients with brain metastases, stable extracranial disease, higher BED10-SRT (≥50Gy) and targeted therapy may predict a favorable prognosis.

KN035 in Patients With Advanced Multiple Primary Tumors

KN035 in Patients With Advanced Multiple Primary Tumors

Synchronous multiple primary non-small cell lung cancer or intrapulmonary metastasis from an index lesion: a dilemma—case report

: Lung cancer is considered one of the major causes of cancer-related mortality. Our case report wishes to highlight the confusion one may have when faced with a lesion that could be a synchronous lesion or metastasis from an index lesion, and its management including whether re-do VATS is a good option. We report our case of a 68 years old male who came to our attention in March 2018 with history of weight loss and repeated chest infections. He was smoking until he was reviewed in our clinic, with a 40-pack year history. PET scan revealed an intense uptake of left lower nodule of size 3.5 cm (cT2aN0M0). He underwent uniportal VATS left basal segmentectomy and lymphadenectomy with the histopathology confirming a squamous cell carcinoma (SCC) (pT2aN0M0R0). During his follow-up, a new left upper lobe lesion was noticed in February 2019. PET scan showed increased uptake in the lesion and CT guided biopsy showed poorly differentiated SCC (cT1cN0M0). The patient underwent uniportal VATS left upper trisegmentectomy and lymphadenectomy with histopathology revealing the presence of two different lesions this time around: the larger one being a SCC with a staging of pT1cN0M0R0 and the smaller being a basaloid type of SCC with a staging of pT1aN0M0. In our opinion, the three cancerous nodules the patient developed represented multiple primary tumours arising on a background of field change rather than intrapulmonary metastasis from an index lesion (differentiating this was important from management point of view). Moreover, we managed to safely perform a redo surgery via uniportal VATS for the same sided lung lesion. This is feasible as long as the patient has an adequate cardiorespiratory function. We wish to take this opportunity to add to the literature our experience with this case of multiple primary lung cancer (MPLC).