Synchronous Malignancies Research Articles

2697 Gastrointestinal Stromal Tumor Mimicking a Small Lymphocytic Lymphoma

INTRODUCTION: Gastrointestinal stromal tumors (GIST) have been associated with synchronous or metachronous secondary malignancies in up to 43% cases. The occurrence between GIST and hematological malignancies is approximately 7%. Here, we present a case of a GIST mimicking Small Lymphocytic Lymphoma (SLL). CASE DESCRIPTION/METHODS: A 70-year-old male presented with a one-month history of bilateral axillary lymphadenopathy. Physical exam revealed a conglomerate of lymph nodes of both axillary regions. CT of the chest-abdomen-pelvis showed diffuse axillary, mesenteric, retroperitoneal and inguinal lymphadenopathy. In addition, it showed a 40 mm mass in the lesser curvature of the stomach (Figure 1). FNA of the axillary region showed findings consistent with SLL. Upper endoscopy showed a large subepithelial mass in the stomach (Figure 2). Biopsies were taken with cold forceps showing reactive white blood cells, this was suspected to be lymphoma. The patient was diagnosed with Stage IV SLL and started on Ibrutinib. Three months after therapy was started, CT revealed significantly improved on adenopathy but an increase in the size of the gastric mass. A repeat upper endoscopy with endoscopic ultrasound (EUS) showed a hypoechoic, heterogeneous round mass with well-defined borders, originating from muscularis propria layer (Figure 3). Fine needle biopsy (FNB) was performed and showed clusters of neoplastic cells, positive for CD117 and DOG1, negative for CK7, CK20, and CDX2, consistent with a GIST. DISCUSSION: Little is known about the coexistence of GIST and other metachronous tumors of different anatomic location. Several theories have been proposed to explain this link. These theories include pro-oncogenic changes in the tissue microenvironment, carcinogenic effect by chemotherapy and desmoid-type fibromatosis after trauma or surgery. When located in the stomach, GISTs most commonly present as subepithelial lesions. Since mucosal biopsies have a false negative rate of almost 50%, additional evaluation with EUS and EUS guided tissue acquisition is of essential importance. Obtaining core samples by FNB is useful for tissue architecture evaluation and immunohistochemistry assessment of the sample. In this particular case, EUS was not performed initially; instead, mucosal biopsies were obtained leading to a false negative result. This case highlights the rare association between GISTs and other malignancies, as well as, the importance of EUS for the evaluation and accurate diagnosis of different subepithelial lesions.

Metachronous and Synchronous Cancers in Patients with Neuroendocrine Tumors

Introduction: Neuroendocrine tumors (NETs) are a heterogeneous group of malignancies with various clinical presentations and growth rates. NET incidence has been estimated to 2.5–5 per 100,000 people per year, and NET prevalence is 35 per 100,000. They are frequently associated with synchronous or metachronous second primary malignancies (SPM). Methods: We retrospectively reviewed our institutional database on NET patients. We report on 30 patients with NETs and SPMs from a series of 262 patients with NETs: 10 patients with synchronous NETs (33.3%) and 20 with metachronous SPMs (66.6%). Results: The median patient age was 67 years. Of the 10 synchronous lesions, 50% were observed in the GI tract. The most common locations of these lesions were the colon (15%) and pancreas (25%). In 2 patients, there was an association of prostate neoplasia with a subsequent NET of the pancreas. Conclusions: Only few studies have examined the association between NETs and SPMs. Our study showed that the risk of second cancer following NETs is increased. In this single-institution retrospective review, our incidence of additional malignancies in patients with NET was 11.4%.

Use of Isocenter Bilateral Tangential Fields Combined with Intensity-Modulated Radiation Therapy for Synchronous Bilateral Whole-Breast Irradiation: A Dosimetric Study

Synchronous malignancy in both breasts is a rare incidence. Delivery of irradiation in women with bilateral breast conserving surgery (BCS) represents a technical challenge. The present study aims at dosimetric investigation of the technical feasibility and outcome of a single isocenter bilateral tangential field (IBTF) combined with intensity modulated radiation therapy (IMRT) in bilateral breast radiotherapy (BBR). Fourteen women with synchronous bilateral breast cancer (SBBC) after breast conserving surgery (BCS) were treated in our hospital. All received BBR using IBTF combined with IMRT technique. The conventional (50Gy/25f) or hypofractionated (43.5Gy/15) dose that was commonly applied in our institution was delivered to the whole breast. 2 tangential fields were given to each breast, delivering 70-80% of the whole dose to breast. The 20-30% of the dose was delivered using IMRT fields to reduce the higher dose volumes and improve homogeneity index. For patients with invasive cancer, the additional tumor bed boost was given with sequential electron radiation or simultaneously photon IMRT. The dosimetric parameters as well as clinical outcomes including local recurrence rate and toxicities were evaluated. The median age of enrolled patients was 51(40-69). All patients with bilateral breast cancer were in pTis-2N0-1M0 stage. The radiation plans used 8-11 fields, including 4 tangential ones. The bilateral breast PTV reached 95% of the prescription dose in all plans. For tumor bed, the dose coverage were 95.54±1.33%(left), 94.19±1.03%(right) using photon while 90.25±8.79%(left) and 85.28±8.35%(right) using electron; V107 of tumor bed were 11.8±9.55%(left), 13.23±13.01%(right) using photon, while 21.32±36.94%(left) and 0 using electron. The mean V5 and V20 of lungs were 32.36±7.01% and 16.69 ±3.90%, while the mean heart and LAD Dmean were 5.48Gy and 17.79±7.14Gy. Only three (21.4%) patients had grade II acute skin toxicities. No ≥ Grade 2 pneumonitis was observed. No recurrence occurred with the median follow up time of 30.1 months. Eleven patients showed excellent cosmetic results. This dosimetric study of demonstrates that BBR using IBTF combined with IMRT technique for patients with SBBC after BCS is safe and effective.

Burden of lymphatic disease predicts efficacy of adjuvant radiation and chemotherapy in FIGO 2018 stage IIICp cervical cancer

ObjectiveNodal involvement is one of the most important prognostic factors in cervical cancer patients. We aimed to assess the prognostic role in relation to the burden of nodal disease in...

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 Patient with Synchronous Primary Hepatocellular Carcinoma and Primary Pancreatic Ductal Adenocarcinoma

The incidence of synchronous double primary malignancies is rare. There were only two cases with synchronous hepatocellular carcinoma (HCC) and pancreatic cancer has been reported so far (J Surg Case Rep 2017(9):rjx182, 2017; Indian J Palliat Care 20:53–6, 2014). Whether double primary malignancies to be operable is an interesting and important issue for surgeon. Here, we report a rare case of synchronous double primary malignancies of the liver and pancreas received simultaneous hepatic segmentectomy and pancreaticoduodenectomy.

Thirty-Two Case Reports of Synchronous Hematological Malignancy and Solid Tumor

Thirty-Two Case Reports of Synchronous Hematological Malignancy and Solid Tumor

PF486 THE IMPACT OF PRIOR MALIGNANCIES ON THE DEVELOPMENT OF SECOND MALIGNANCIES AND SURVIVAL IN PATIENTS WITH FOLLICULAR LYMPHOMA: A NATIONWIDE POPULATION‐BASED STUDY IN THE NETHERLANDS

Background:Advances in the treatment of follicular lymphoma (FL) have considerably improved survival in FL. This success, however, might come at price, as FL patients correspondingly life long enough to potentially develop second primary malignancies (SPMs). A prior study among multiple myeloma (MM) factorpatients showed that a prior malignancy diagnosis (PMD) 3/4 as potential proxy for genetic susceptibility to cancer 3/4 was associated with SPM development and mortality after MM diagnosis (Jonsdottir, Blood Adv, 2017). At present, information on the impact of a PMD on the development of a SPM and mortality in FL is lacking.Aims:The aim of this nationwide population‐based study was to assess the impact of a PMD on the development of a SPM and survival in patients with FL in the Netherlands.Methods:We selected all adult FL patients diagnosed between 1994–2012 from the Netherlands Cancer Registry (NCR). PMDs and SPMs (excluding basal cell carcinoma) relative to FL were identified from the NCR and classified into subgroups as per the third edition of the International Classification of Diseases for Oncology (Fig 1A). Synchronous malignancies diagnosed within a time‐interval of 6 months prior to or after FL diagnosis (n = 300) were excluded. We used competing risk regression as per Fine and Gray 3/4 with death as a competing risk 3/4 to estimate sub‐distribution hazard ratios (SHRs) with 95% CIs for the association between a PMD before FL diagnosis and the development of a first SPM after FL diagnosis. These associations were also calculated for subgroups of SPMs. Cox regression was used to calculate hazard ratios (HRs) with 95% CIs to assess the risk of death associated with a PMD. All patients were followed from date of FL diagnosis to date of first SPM, death, or end of follow‐up (February 1, 2017). We adjusted all analyses for baseline characteristics at FL diagnosis (i.e. sex, year of diagnosis, age, and disease stage). Further, we examined the effect of additional adjustment for anti‐neoplastic therapy of PMDs and FL treatment started within one year after diagnosis (chemotherapy, radiotherapy only, no therapy, other therapy) on the effect estimates for a PMD. A P < 0.05 indicated statistical significance.Results:We included 9,251 patients, of whom 672 (8.1%) had ≥1 PMD. At a median follow‐up of 6.9 years (range <0.1–23.0), patients with a PMD developed a SPM more often than patients without a PMD (23% v 15%; P < 0.001). Further, patients with a PMD were older at FL diagnosis (median age, 70 v 60 years; P < 0.001) and more often female (50% v 42%; P < 0.001). Overall, a PMD was associated with an increased rate of a SPM (Fig 1B), with an adjusted SHR of 1.67 (95% CI 1.39–2.00; P < 0.001). This association was statistically significant for the following subgroups of SPMs: breast‐ and lung cancer and melanomas and squamous cell carcinomas of the skin (P < 0.05). Further, a PMD was associated with an increased risk of death (adjusted HR, 1.19; 95% CI, 1.07–1.33; P < 0.001). The increased rate of SPMs and risk of death associated with a PMD was irrespective of the type of therapy applied for PMDs or FL, as additional adjustment for these factors did not affect the effect estimates.Summary/Conclusion:We demonstrated an association between a PMD and the development of a SPM and survival among patients with FL. Since additional adjustment for therapy did not alter the direction or magnitude of these associations, our results might suggest a role for genetic susceptibility to cancer. We encourage future studies to corroborate on the association between a PMD and SPM development in FL.image

PS1386 CARFILZOMIB AS PART OF A DOSE DENSE, LESS DOSE INTENSE TOTAL THERAPY APPROACH FOR HIGH RISK MYELOMA

Background: Jonsdottir et al. (Blood Adv. 2017) recently suggested that, among the population of Sweden, a prior malignancy diagnosis (PMD) before the onset of MM increases the risk for developing a subsequent primary malignancy (SPM) after multiple myeloma (MM). Their analysis, however, did not account for death before the onset of a SPM as a competing risk. Therefore, their risk estimates might overestimate the magnitude of SPM development. Aims: To complement and extend on their observations, we revisited their analysis on the impact of a PMD on the first onset of a SPM in MM by employing competing risk regression. Methods: We identified all MM patients diagnosed between 1994–2012 from the nationwide population-based Netherlands Cancer Registry (NCR). PMDs and SPMs-excluding basal cell carcinomas-relative to MM were identified from the NCR. Synchronous malignancies diagnosed ≤6 months prior to or after MM diagnosis, and malignancies diagnosed from autopsies were excluded. SPMs were classified into subtypes according to the 3rd edition of the International Classification of Diseases for Oncology. We used competing risk regression as per Fine and Gray 3/4 with death before the onset of a SPM as a competing risk 3/4 to estimate sub-distribution hazard ratios (SHRs) with 95% confidence intervals (CIs) for the association between a PMD in MM patients and the development of a first SPM overall. These associations were also calculated for the subtypes as per SPM. We used Cox regression to calculate hazard ratios (HRs) with 95% CIs for the association between a PMD and the risk of mortality. All analyses were adjusted for baseline MM characteristics (i.e. sex, age, and period of diagnosis). All patients were followed from date of MM diagnosis to date of first SPM, death or end of follow-up (February 1, 2017), whichever came first. A P < 0.05 indicated statistical significance. Results: Our analytic cohort included 16,710 MM patients, of whom 1,760 (10.5%) had at least one PMD. Patients with a PMD were older at MM diagnosis, as compared to those without (median age 76 vs. 70; P < 0.001). At a median time of 3.8 years from MM diagnosis to first SPM (range 0.5–19.4), 138 of 1,760 (7.8%) MM patients with a PMD developed a SPM, as compared to 1,079 of 14,950 (7.2%) MM patients without (P = 0.341). Overall, there was no evidence for an increased rate of a first SPM in MM patients with a history of PMD, as compared to those without a history of PMD (adjusted SHR, 1.15; 95% CI, 0.96–1.38; P = 0.131; Table). However, subgroup analyses showed that there was an increased rate of breast cancer as first SPM in patients with a history of PMD (adjusted SHR, 2.45; 95% CI, 1.04–5.78; P = 0.040; Table) and melanoma of the skin (adjusted SHR, 3.05; 95% CI, 1.26–7.37; P = 0.014; Table). Finally, there was no statistically significant association of a PMD with the risk of mortality (adjusted HR, 1.04; 95% CI, 0.98–1.10; P = 0.177).Summary/Conclusion: In this population-based study, there was no apparent overall association between a history of a PMD and the development of a SPM among MM patients. However, subtype analyses showed increased rates for breast cancer and melanoma of the skin. Our results are not entirely in line with those of Jonsdottir et al. Of note, since we accounted for death before the onset of a SPM as a competing risk, our estimates are unlikely to be plagued by overestimation. Moreover, our results may guide cancer surveillance for early detection and appropriate management of SPMs, as MM survivorship is expected to increase due to continues therapeutic advances.

PS1385 THE IMPACT OF A PRIOR MALIGNANCY ON THE DEVELOPMENT OF A SUBSEQUENT MALIGNANCY IN MULTIPLE MYELOMA REVISITED: A COMPETING RISK ANALYSES

Background:Jonsdottir et al. (Blood Adv. 2017) recently suggested that, among the population of Sweden, a prior malignancy diagnosis (PMD) before the onset of MM increases the risk for developing a subsequent primary malignancy (SPM) after multiple myeloma (MM). Their analysis, however, did not account for death before the onset of a SPM as a competing risk. Therefore, their risk estimates might overestimate the magnitude of SPM development.Aims:To complement and extend on their observations, we revisited their analysis on the impact of a PMD on the first onset of a SPM in MM by employing competing risk regression.Methods:We identified all MM patients diagnosed between 1994–2012 from the nationwide population‐based Netherlands Cancer Registry (NCR). PMDs and SPMs‐excluding basal cell carcinomas‐relative to MM were identified from the NCR. Synchronous malignancies diagnosed ≤6 months prior to or after MM diagnosis, and malignancies diagnosed from autopsies were excluded. SPMs were classified into subtypes according to the 3rd edition of the International Classification of Diseases for Oncology. We used competing risk regression as per Fine and Gray 3/4 with death before the onset of a SPM as a competing risk 3/4 to estimate sub‐distribution hazard ratios (SHRs) with 95% confidence intervals (CIs) for the association between a PMD in MM patients and the development of a first SPM overall. These associations were also calculated for the subtypes as per SPM. We used Cox regression to calculate hazard ratios (HRs) with 95% CIs for the association between a PMD and the risk of mortality. All analyses were adjusted for baseline MM characteristics (i.e. sex, age, and period of diagnosis). All patients were followed from date of MM diagnosis to date of first SPM, death or end of follow‐up (February 1, 2017), whichever came first. A P &lt; 0.05 indicated statistical significance.Results:Our analytic cohort included 16,710 MM patients, of whom 1,760 (10.5%) had at least one PMD. Patients with a PMD were older at MM diagnosis, as compared to those without (median age 76 vs. 70; P &lt; 0.001). At a median time of 3.8 years from MM diagnosis to first SPM (range 0.5–19.4), 138 of 1,760 (7.8%) MM patients with a PMD developed a SPM, as compared to 1,079 of 14,950 (7.2%) MM patients without (P = 0.341). Overall, there was no evidence for an increased rate of a first SPM in MM patients with a history of PMD, as compared to those without a history of PMD (adjusted SHR, 1.15; 95% CI, 0.96–1.38; P = 0.131; Table). However, subgroup analyses showed that there was an increased rate of breast cancer as first SPM in patients with a history of PMD (adjusted SHR, 2.45; 95% CI, 1.04–5.78; P = 0.040; Table) and melanoma of the skin (adjusted SHR, 3.05; 95% CI, 1.26–7.37; P = 0.014; Table). Finally, there was no statistically significant association of a PMD with the risk of mortality (adjusted HR, 1.04; 95% CI, 0.98–1.10; P = 0.177).Summary/Conclusion:In this population‐based study, there was no apparent overall association between a history of a PMD and the development of a SPM among MM patients. However, subtype analyses showed increased rates for breast cancer and melanoma of the skin. Our results are not entirely in line with those of Jonsdottir et al. Of note, since we accounted for death before the onset of a SPM as a competing risk, our estimates are unlikely to be plagued by overestimation. Moreover, our results may guide cancer surveillance for early detection and appropriate management of SPMs, as MM survivorship is expected to increase due to continues therapeutic advances.image

Synchronous Urothelial Bladder and Renal Malignancies. Case Report and Review of Urologic Cancers in Patients With Familial Rb Mutations

We present a urologic case report associated with retinoblastoma (RB1) mutation. A 65-year-old man, who has a history of bilateral retinoblastoma treated with primary radiation therapy at approximately 1 year of age. He presented with a 3-month history of gross hematuria and, on initial workup, was found to have synchronous renal and urothelial malignancies. The patient underwent complete transurethral resection of high grade Ta urothelial cancer and robotic-assisted partial nephrectomy for a pT3a leiomyosarcoma. He remains responsive to Bacillus Calmette-Guerin, and shows no recurrence of his renal malignancy. Through targeted sequencing, Rb mutations can predispose patients to several urologic malignancies.

Role of 18F-fluorodeoxyglucose positron emission tomography/computed tomography in restaging and prognosis of recurrent melanoma after curative surgery.

Malignant melanoma is a highly aggressive tumor and surgical resection is the primary treatment. However, the chances of recurrence are quite high despite complete resection. The aim of study was to evaluate the 18F-fluorodeoxyglucose(18F-FDG) positron emission tomography–computed tomography (PET/CT) in detection of recurrent melanoma after curative surgery and its prognostic value. Fifty-four melanoma patients (32 women) with prior primary lesion resection were evaluated with 18F-FDG PET/CT for clinically suspicious recurrent disease. The diagnostic accuracy of 18F-FDG PET/CT (visual interpretation as well as semi-quantitative parameter) was determined on the basis of subsequent imaging and clinical follow-up. Melanoma-specific survival and risk of progression (hazard ratio [HR]) were assessed using Kaplan–Meier method and Cox regression analysis. 18F-FDG PET/CT detected recurrent diseases in 36 (66%) patients including distant metastases in 13 patients and second synchronous malignancy in 2 patients. Overall, the sensitivity, specificity, positive predictive value, and negative predictive value of 18F-FDG PET/CT were 91.2%, 80.0%, 88.6%, and 84.2%, respectively, with area under the curve of 0.86 (95% confidence interval: 0.74–0.97; P < 0.05). Positive 18F-FDG PET/CT study was associated with a significantly shorter overall survival than negative study (30.8 ± 4.6 vs. 64.5 ± 6.9 months, P < 0.05). Apart from positive 18F-FDG PET/CT scan, maximum standardized uptake value (SUVmax) >2.7 and combination of both were independently associated with an increased risk of disease progression (HR = 7.72, 21.58, and 11.37, respectively; P < 0.05). 18F-FDG PET/CT showed enhanced diagnostic performance in patients with suspicious recurrent malignant melanoma leading to appropriate management. FDG positivity along with SUVmax >2.7 provides important prognostic value in predicting the survival outcomes and assessing the risk of disease progression.

Synchronous and metachronous head and neck squamous cell carcinoma in western Australia—a single center experience

Background: Despite advances in multimodality treatment of head and neck squamous cell carcinoma (HNSCC), survival outcomes have improved minimally. This may be attributable to the increased risk of secondary primary malignancies. We conducted a retrospective analysis of patients treated at Fremantle Hospital, Western Australia with HNSCC to investigate the incidence of second primary malignancy (SPM), the epidemiological risk factors and survival outcome. Methods: We analyzed 790 patients from our departmental head and neck oncology database with the diagnosis of synchronous and/or metachronous HNSCCs between 1993 and 2011. We analyzed for an association between the risk factors and survival outcomes using the Statistical Package for Social Sciences for statistical analysis. Results: The commonest HNSCC was lip and oral cavity (37.8%), followed by oropharynx (28.1%) and larynx (26.5%). Of the 790 patients, 55.9% were smokers, 36.8% had a smoking history of over 50 pack-years, and 41.1% had a history of alcohol use. Primary treatment included surgery, surgery/radiotherapy, chemotherapy, surgery/chemotherapy, surgery/chemo-radiotherapy, radiotherapy, chemo-radiotherapy, and palliative, or no treatment. Synchronous tumour occurred in 29 patients (3.7%). Eighteen patients (2.3%) had metachronous tumour: median follow-up period was 25 months; 178 patients (22.5%) were dead at the end of follow-up. Conclusions: While this study found a lower rate of secondary primary malignancies in patients with HNSCCs than other studies, there was a clear association between patients with significant smoking histories and the development of HNSCCs. Progression to synchronous or metachronous malignancy was associated with a poorer overall survival rate.

Well-Differentiated Papillary Mesothelioma of the Peritoneum: A Retrospective Study from the RENAPE Observational Registry.

Well-differentiated papillary mesothelioma of the peritoneum (WDPMP) is a rare entity. Questions regarding management are still being debated as no more than 50 cases have been reported in the literature. We aimed to analyze the clinical, therapeutic, and prognostic data of patients with WDPMP from the RENAPE observational registry. All patients diagnosed with WDPMP and prospectively included in the RENAPE national registry between 2010 and 2018 were also included in our study. Expert pathologists from the RENA-PATH group confirmed all cases. All clinical, therapeutic, postoperative, and prognostic data were extracted and analyzed. We report on 56 patients with a mean age of 52years (range 21-74). WDPMP was incidentally diagnosed during imaging or surgery in 16% and 36% of patients, respectively, and an association with synchronous malignancy was found in 18% of patients. Nine lesions showed discrete signs of fatty invasion. The median Peritoneal Cancer Index was 11 (range 0-33). Eleven patients were treated with definitive excision, 4 were treated with cytoreductive surgery (CRS) only, 37 were treated with CRS and hyperthermic intraperitoneal chemotherapy (HIPEC), and 2 were treated with CRS plus HIPEC plus early postoperative intraperitoneal chemotherapy. CRS was considered to be complete in 90% of cases. One patient died postoperatively and 16 patients (31%) faced postoperative complications. The median disease-free survival was 144months; Four patients relapsed, with a median period of 27months. No prognostic factors could be identified. Our analysis confirms the favorable prognosis of WDPMP. CRS and HIPEC could be a therapeutic option for diffuse, symptomatic, and/or recurrent disease.

Every distant deposit is not a metastasis: Synchronous primaries do exist.

Synchronous occurrence of two malignant tumors is a rare event. With increasing use of sophisticated imaging modalities for staging, synchronous multiple tumors are more commonly detected now. Assuming the second primary malignancy as metastasis will change the intent of treatment from curative to palliative, greater awareness among oncologists is of paramount importance. This study is an example where thorough clinical examination and proper judgment resulted in correct diagnosis and appropriate treatment. This is a prospective descriptive study. Patients diagnosed with synchronous primary tumors from January 2016 to November 2017 at our center were reviewed. Ten cases of synchronous primary malignancies were detected during this period. A total of 20 primary tumors were diagnosed. Lung carcinoma and gastrointestinal malignancies were the most common (five patients each). The median age was 59.5 years. Seven patients were male. Second primary tumor was suspected in four patients during clinical examination, while in six patients it was suspected on imaging. Even in the presence of two primary tumors, three patients were treated with curative intent. Possibility of synchronous second primary malignancy should always be kept whenever a distant deposit is detected at an unusual site. Histopathological evaluation of the lesion before assuming a metastasis will lead to accurate diagnosis, staging, and appropriate treatment.

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.

Incidental findings on 18-FDG PET\u2013CT in head and neck cancer. A retrospective case-control study of incidental findings on 18-FDG PET\u2013CT in patients with head and neck cancer

PurposeUse of 18-FDG PET–CT is increasing in patients with head and neck cancer, enabling the identification of metastases or synchronous malignancies, but also ‘incidental’ disease. We aimed to establish the rate of ‘incidental’ findings resulting from 18-FDG PET-specific imaging, that would not have been otherwise identified on other imaging, in patients with head and neck cancer undergoing staging or surveillance of disease.Methods18-FDG PET–CT was performed for investigation or surveillance. Case notes were reviewed retrospectively. Unexpected findings identifiable on CT imaging alone, or by FDG-PET were recorded. For those only identifiable with FDG-PET, findings were divided into either ‘incidental’ or ‘intentional’, and benign or malignant.Results93 patients underwent 18- FDG PET–CT. 86.0% had new pathology identified. 3.2% had a new malignancy identified. 37.6% had new findings on FDG-PET that would not have been identified on CT alone: 5.4% had ‘intentional findings’ (metastasis), and 32.3% had ‘incidental findings’ (synchronous malignancy or benign). 1.1% had a new malignancy on FDG-PET alone.ConclusionsIntentional and incidental findings are likely on 18-FDG PET–CT. Whilst important for patient management, there is an associated emotional and financial cost, which needs acknowledgement and further investigation.

Coincident primary breast lymphoma and gastrointestinal stromal tumor: case series and molecular mechanisms.

Gastrointestinal stromal tumor (GIST) is an uncommon mesenchymal tumor, and has been shown to be associated with synchronous or metachronous second malignancies. Rare cases of coincident GIST and non-Hodgkin lymphomas (NHL) have been reported previously. Here, we report two cases of GIST and coincident primary breast lymphoma, an uncommon subtype of extranodal NHL. We propose that the exceedingly low likelihood of both these cancers occurring in these two patients by chance warrants examination for possible common oncogenic pathways in these lesions, possibly involving shared anti-apoptotic mechanisms. Further research is vital to elucidate common oncogenic pathways between such rare lesions.

Prognosis associated with synchronous or metachronous multiple primary malignancies in patients with completely resected non-small cell lung cancer.

To investigate the influence of multiple primary malignancies (MPMs) on the prognosis of patients with completely resected non-small cell lung cancer (NSCLC). The subjects of this retrospective study were 521 patients who underwent complete curative pulmonary resection for NSCLC. Patients were divided into two groups: those with and those without MPMs. The 521 NSCLC patients included 184 patients (35.3%) with MPMs and 337 patients without MPMs. The overall 5-year survival rates for patients with vs those without MPMs were 66.1 and 75.6%, respectively (p = 0.0061). According to multivariate analysis, MPMs, age, gender, pathological stage, and interstitial pneumonia were independent predictors of prognosis. The 47 patients with synchronous MPMs and the 82 patients with metachronous MPMs found within the last 5years had significantly poorer prognoses than patients without MPMs (p = 0.0048 and p = 0.0051, respectively). However, the prognoses of the 55 patients with metachronous MPMs that had been present for over 5years did not differ from those of the patients without MPMs. NSCLC patients with synchronous MPMs or metachronous MPMs diagnosed within the last 5years had poor prognoses. Decisions about the best therapeutic strategies require comprehensive consideration of the organ location, malignant potential, recurrence, and prognosis of the MPMs. In contrast, decisions about the best therapeutic strategies for NSCLC patients with metachronous MPMs present for over 5years should be based solely on the NSCLC.

Potential Application of Bone Scintigraphy in Nasopharyngeal Carcinoma With Skull Base and Adjacent Bony Involvement

Background: Bone scintigraphy has an established role to evaluate skeletal metastasis by detecting lesions earlier compared with radiographic changes. Skull base and adjacent bony involvement could possibly be evaluated using bone scintigraphy and might influence nasopharyngeal carcinoma (NPC) treatment planning. Skull base lesions in NPC are also associated with concomitant skeletal metastases. Aim: To determine clinical characteristics of NPC patients with skull base lesions and adjacent bony involvement who underwent bone scintigraphy and their scan findings. Methods: Bone scintigraphy performed for 87 NPC patients between June 2014 and February 2018. Whole-body imaging acquired at 3 hours after 99mTc methylene diphosphonate (MDP) injection. Clinical information and scintigraphic findings were compiled. Patients with prior evidence and/or bone scintigraphic features of skull base lesions or adjacent bony involvement were included (n = 46). Synchronous malignancy or ongoing bone infection cases were excluded. Results: 17 patients had prior evidence of skull base or adjacent bony involvement that were all subsequently positive on bone scintigraphy. We detected another 29 patients with MDP-avid skull base or adjacent bony involvement. Average age of entire cohort was 51 years. Approximately 78% were males. Majority were ethnic Chinese (48%). Most patients (57%) had stage 4 diseases prior to bone scintigraphy with 9 patients demonstrating distant metastasis mainly to lungs and bones. Only 28 patients were receiving ongoing treatment. Overall, 18 patients (39%) showed concomitant MDP-avid skeletal metastases on whole-body imaging. Patients whom already had existing documented distant metastasis were significantly associated with concomitant MDP-avid skeletal metastases ( P &lt; 0.05), while other parameters including gender, age, ethnicity, disease staging and treatment status showed no significant correlation. Conclusion: Bone scintigraphy could potentially be used to assess skull base and adjacent bony involvement besides concomitant skeletal metastasis among our cohort of NPC patients.