Occurrence Of Multiple Primary Neoplasms Research Articles

Synchronous case of cutaneous melanoma and gallbladder cancer in a 74-year-old female patient

The occurrence of multiple primary neoplasms is not only a diagnostic but also a therapeutic challenge. We aim to present a case of a 74-year-old woman diagnosed with synchronous primary skin melanoma and gallbladder cancer. We showed the diagnostic process, applied treatment, and referenced it to the literature data.

Multiple primary neoplasms in patients with testicular germ cell tumor.

The study of multiple primary neoplasms may provide more insight into the pathogenesis of specific cancers and, secondly, it addresses the issue of treatment-related induction of second tumors. 584 consecutive patients with testicular germ cell tumors treated during 1969-1992 in Berlin were retrospectively analyzed for the prevalence of multiple primary neoplasms. 23 patients (16 pure seminoma, 7 nonseminoma) developing nontesticular malignancies in addition to testis cancer were identified (3.9%, 95 confidence intervals +/- 1.6%). The mean age at the time of the testis cancer was 42.8 years, and mean age at the time of nontesticular malignancy was 50.2 years. In 4 cases, the nontesticular malignancy preceded testis cancer, in 3 patients both neoplasms occurred simultaneously, and in 16, nontesticular malignancies developed subsequently to testis cancer. In 4 patients, triple malignancies were observed. Bladder carcinoma and bronchogenic cancer with each 3 cases were the most frequent second neoplasms seen in these patients. 9 consecutive cancers developed within radiation fields, the median latency period in these cases was 12 years. None of the subsequent cancers developed after chemotherapy. It is concluded that genetic predisposition and radiation effects are the most important factors contributing to the occurrence of multiple primary neoplasms in patients with testicular germ cell cancer. The high rate of multiple primary neoplasms in these patients lends further evidence to the theory of genetic anticipation of germ cell cancer.

Multiple primary malignant tumors of the head and neck

Multiple primary malignant tumors associated with an index cancer in the head and neck are gaining attention as more patients survive their initial primary disease, the longevity of the population at large increases, health care delivery becomes more readily available, and sophisticated diagnostic technology is developed. Forty-four patients with multiple primary cancer in whom the index neoplasm was inthe head and neck are reported. This group comprises 17 per cent of the patients with head and neck cancer treated at the Detroit General Hospital in the last 10 years. Forty-seven per cent of the cancers occurred simultaneously, 10 per cent were synchronous (discovered within six months), and 43 per cent were metachronous (discovered later than six months). Eighty-six per cent of the patients are dead; 75 per cent died within one year after the diagnosis of the secondary primary cancer. Patients with simultaneously occurring malignant tumors appeared to have a somewhat poorer prognosis than those with metachronously occurring tumors. Although the highest incidence of multiple primary malignant tumors occurs in the first year, a consistent high incidence puts the patient with a solitary neoplasm at risk well beyond the three to five years of survival usually considered as "cure." Although no factor other than coincidence has been proved to be involved in the pattern of occurrence of multiple primary neoplasms of different tissues or organs, this study does corroborate other reported data that emphasize that patients with head and neck cancer are at greater risk of developing a second primary malignant tumor in the multicentric vicinity of the original lesion, and in the esophagus and lung than the general population. A program of management and post-treatment surveillance is presented. The potential for new primary malignant neoplasms to develop in the multicentric vicinity of the original lesion and in remote organs cannot be approached with detached curiosity.

Laryngeal Carcinoma Associated With Multiple Additional Primary Tumors

Four malignant tumors and one benign in a 76-year-old man appeared. Three of the neoplasms were in the respiratory system, and one was a bladder carcinoma; all were linked to heavy smoking habits. The patient underwent immunologic investigations consisting of in vivo testing for cutaneous reactivity, in vitro lymphocyte blastogenesis studies, T- and B-cell level studies, and serum immunoglobulin level studies. The studies have demonstrated anergy to recall antigens, decreased lymphocyte responses to phytohemagglutinin, and low levels of peripheral T-lymphocytes. The serum immunoglobulins were at the upper limit of the normal. The relationship between the patient's immunologic status and the occurrence of multiple primary neoplasms is discussed.

Double primary tumors of the larynx and lung.

THE OCCURRENCE of multiple primary neoplasms in the same or different organ systems in a patient is not uncommon.1-4The incidence of multiple malignancies in autopsy material has been reported as high as 6.8%.5In selected clinical situations the incidence is even higher.6Surgeons and radiotherapists, who see a large number of patients with laryngeal carcinoma, are aware of the high frequency of a second primary occurring in the lung.7,8 When the lung is second of the two organs involved, the issue as to whether or not the lung lesion represents a metastasis must be considered. In 1941 Braund and Martin9pointed out that metastases below the clavicle from a laryngeal tumor was rare without extensive involvement of the cervical lymph nodes. This impression was corroborated by Latella10in the study of the terminal phase of 240 patients with carcinoma of the larynx when