Synchronous Malignancies Research Articles

A rare incidental case of an occult breast carcinoma micrometastasis in papillary thyroid carcinoma: A view within a view

Metastasis to thyroid gland is rare, accounting for only 2%–3% of malignant lesions of thyroid and if present, is associated with a poor prognosis. Herein, we describe a case of a 42-year-old female who presented initially with papillary carcinoma of the thyroid and a synchronous malignancy was pointed toward on the basis of a secondary population of atypical cells in intrathyroidal as well as perithyroidal blood vessels emboli. Immunohistochemistry and systematic review of the patient later proved the micrometastasis to be that of carcinoma breast for which the patient was operated 6 years ago. The present case is worth reporting because it documents the presence of two different cancers in a single-organ system (a rare presentation of breast ductal cancer metastasizing to the papillary thyroid carcinoma) by the means of an important yet overlooked lymphovascular compartment, by the identification of the metastatic tumor emboli.

Elderly Woman with Synchronous Triple Malignancies of Small Lymphocytic Lymphoma, Multiple Myeloma and Mucosal Malignant Melanoma

Elderly Woman with Synchronous Triple Malignancies of Small Lymphocytic Lymphoma, Multiple Myeloma and Mucosal Malignant Melanoma

Hereditary Nonpolyposis Colorectal Cancer and Cancer Syndromes: Recent Basic and Clinical Discoveries.

Approximately one-third of individuals diagnosed with colorectal cancer have a family history of cancer, suggesting that CRCs may result from a heritable component. Despite the availability of current gene-identification techniques, only 5% of all CRCs emerge from well-identifiable inherited causes for predisposition, including polyposis and nonpolyposis syndromes. Hereditary nonpolyposis colorectal cancer represents a large proportion of cases, and robustly affected patients are at increased risk for early onset, synchronous, and metachronous colorectal malignancies and extracolonic malignancies. HNPCC encompasses several cancer syndromes, such as Lynch syndrome, Lynch-like syndrome, and familial colorectal cancer type X, which have remarkable clinical presentations and overlapping genetic profiles that make clinical diagnosis a challenging task. Therefore, distinguishing between the HNPCC disorders is crucial for physicians as an approach to tailor different recommendations for patients and their at-risk family members according to the risks for colonic and extracolonic cancer associated with each syndrome. Identification of these potential patients through epidemiological characteristics and new genetic testing can estimate the individual risk, which informs appropriate cancer screening, surveillance, and/or treatment strategies. In the past three years, many appealing and important advances have been made in our understanding of the relationship between HNPCC and CRC-associated syndromes. The knowledge from the genetic profile of cancer syndromes and unique genotype-phenotype profiles in the different syndromes has changed our cognition. Therefore, this review presents and discusses HNPCC and several common nonpolyposis syndromes with respect to molecular phenotype, histopathologic features, and clinical presentation.

A Rare case of synchronous primary malignancies of gall bladder and ovary

A Rare case of synchronous primary malignancies of gall bladder and ovary

A case of synchronous malignancy of stomach and kidney

A case of synchronous malignancy of stomach and kidney

Prognosis of Pancreatic Cancer Patients with Synchronous or Metachronous Malignancies from Other Organs Is Better than Those with Pancreatic Cancer Only.

PurposePancreatic cancer associated double primary tumors are rare and their clinicopathologic characteristics are not well elucidated.Materials and MethodsClinicopathologic factors of 1,352 primary pancreatic cancers with or without associated double primary tumors were evaluated.ResultsOf resected primary pancreatic cancers, 113 (8.4%) had associated double primary tumors, including 26 stomach, 25 colorectal, 18 lung, and 13 thyroid cancers. The median interval between the diagnoses of pancreatic cancer and associated double primary tumors was 0.5 months. Overall survival (OS) of pancreatic cancer patients with associated double primary tumors was longer than those with pancreatic cancer only (median, 23.1 months vs. 17.0 months; p=0.002). Patients whose pancreatic cancers were resected before the diagnosis of metachronous tumors had a better OS than patients whose pancreatic cancer resected after the diagnosis of metachronous tumors (48.9 months and 13.5 months, p=0.001) or those whose pancreatic cancers were resected synchronously with non-pancreas tumors (19.1 months, p=0.043). The OS of pancreatic cancer patients with stomach (33.9 months, p=0.032) and thyroid (117.8 months, p=0.049) cancers was significantly better than those with pancreas cancer only (17.0 months).ConclusionAbout 8% of resected pancreatic cancers had associated double primary tumors, and those from the colorectum, stomach, lung, and thyroid were common. Patients whose pancreatic cancer was resected before the diagnosis of metachronous tumors had better OS than those resected after the diagnosis of metachronous tumors or those resected synchronously.

Case Report: Synchronous primary malignancy including the breast and endometrium

Breast and endometrial cancer are the most common types of female cancers, but the incidence of both of these malignancies in a single patient is a rare event. Multiple primary malignancy has been increasingly reported over the past decade, and double primary cancer is considered as the most common type. In this study, we present a 53-year-old woman with synchronous primary malignancy of breast and endometrium. This patient had a history of breast and endometrial cancer in her family. Mammography and chest CT of the patient revealed a mass in the right breast and left supraclavicular region. However, the patient did not want to initiate treatment. Subsequently, the patient returned with a chief complaint of persistent abnormal vaginal bleeding. Abdominopelvic CT scan of the patient revealed a huge soft tissue mass in the pelvic cavity. She underwent hysterectomy, and pathology revealed endometrioid carcinoma, which had invaded the full thickness of uterine wall. Since this type of malignancy is rare and several risk factors are associated with it, it is worth being considered by clinicians when making decisions about screening or strategy for prevention.

Multiple primary malignancies

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

Synchronous malignant neoplasm in the oral cavity - case report

Approximately 555,000 new cases of head and neck cancer (HNC) are diagnosed annually worldwide. Moreover, second primary malignancy (SPM) occurs more commonly in the head and neck than in any other body region. A 67-year-old female patient was admitted to our Department for removal of an upper lip tumor. The patient underwent excision of the lip tumor under general anesthesia. Postoperative histopathology revealed a polymorphic, low-grade adenocarcinoma. Three weeks later, the patient was re-admitted to extend the margin of excision and perform lymphadenectomy. On physical examination, a second primary synchronous lesion was found on the left side of the hard palate. Lymphoscintigraphy was performed to determine the lymph node field and the sentinel lymph node. On ultrasonography, the lymph nodes were not enlarged. Extended excision of the upper lip was performed, and a 5-mm, hard palate tumor was removed with a margin of unchanged tissue. The patient was scheduled for adjuvant treatment. The criteria for a synchronous malignancy are as follows: both tumors must be malignant on histopathology, there must be a distance of at least 2 cm of unchanged mucosa between the index tumor and the primary tumor, the possibility that the second tumor is the metastasis of the index tumor needs to be excluded. In our patient, all these criteria were met. A thorough workup should include medical history, physical evaluation, and imaging, and it should be carried out on every step of treatment and during long-term follow-up in patients after cancer treatment. This is crucial, because not only is there a possibility of recurrence or metastases, but also a considerable percentage of patients may have a second primary lesion.

Synchronous endocrine malignancies (adrenocortical carcinoma and metastatic papillary thyroid cancer) - case report

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Importance of lymph node ratio for locoregional recurrence of squamous cell carcinoma of the buccal mucosa.

There is no published study on the influence of lymph node ratio on locoregional recurrence of squamous cell carcinoma (SCC) of the buccal mucosa. Therefore, we focused in our study on this specific anatomic subsite. We conducted a retrospective chart review of 95 patients from 2003-2013 with treatment-naive SCC of the buccal mucosa. Exclusion criteria were neoadjuvant chemoradiotherapy, perioperative death, N3 disease, unresectable disease, synchronous malignancy, and follow-up <3 months. Statistical analysis was performed using univariate and multivariate analysis. Significant correlations were found between locoregional recurrence and pathologic N classification (P < .001), grading (P = .001), and lymph node ratio (P < .001). Multivariate analysis indicated lymph node ratio as an independent risk factor for locoregional recurrence (P = .002). A cutoff value under 7% led to a 10.383-fold higher risk of incurring a locoregional recurrence. Lymph node ratio is a useful parameter to stratify the risk of locoregional recurrence in patients with SCC of the buccal mucosa.

An Unexpected Cause of Iron Deficiency Anemia: Synchronous Development and Diagnosis of a Rare Gastric Collision Tumor

A 75-year-old man with diabetes and hypertension presented with chest pain and was found to have a ST-elevation myocardial infarction. He was taken to the cardiac catheterization lab for coronary angiography. Following the procedure, he described a several week history of post-prandial epigastric discomfort, for which he was taking naproxen. He denied symptoms of gastrointestinal bleeding. Laboratory data showed iron deficiency anemia (ferritin: 15 ng/mL, hemoglobin: 11.3 g/dL). Esophagogastroduodenoscopy (EGD) demonstrated an irregular, linear, non-bleeding 3 cm ulcer in the stomach body extending into the antrum with a hard consistency (Figure 1), as well as an irregular, cratered, non-bleeding 3 cm ulcer in the gastric cardia with heaped-up margins (Figure 2). Biopsies of the ulcer in the body revealed an invasive moderately differentiated gastric adenocarcinoma (Figure 3, top left and right). Biopsies of the ulcer in the cardia revealed diffuse large B-cell lymphoma (Figure 3, bottom left and right). Histopathology was negative for Helicobacter pylori (H. pylori). The patient underwent subsequent coronary artery bypass grafting and is following with an oncologist for further management. The EGD and histopathologic findings demonstrated synchronous development of a rarely reported collision tumor: gastric adenocarcinoma and diffuse large B-cell lymphoma, each having a distinct endoscopic appearance. Synchronous tumors in the stomach are uncommon. The majority of synchronous malignancies are gastric adenocarcinomas and mucosa associated lymphoid tissue (MALT) lymphomas.1 There have been less than 10 known published reports of the synchronous development of gastric adenocarcinoma and diffuse large B-cell lymphoma.1 This case is also unusual, as H. pylori was not detected on histology. This vignette is significant both for the rarity of the final diagnoses, as well as the reminder that the practicing gastroenterologist provide a thorough endoscopic examination and perform appropriate mucosal sampling, even in the presence of an already identified abnormality. These malignancies would likely have been diagnosed at a later stage had the patient not presented with acute coronary syndrome and undergone endoscopic evaluation for iron deficiency anemia.Figure: Gastric Body Adenocarcinoma.Figure: Gastric Cardia Diffuse Large B-Cell Lymphoma.Figure: Clockwise, from Top Left: Gastric Body Adenocarcinoma (H&E stain, 40x), Invasive Neoplastic Glands (H&E stain, 200x), Gastric Cardia Large Cell Lymphoma (H&E stain, 400x), Diffuse B-Cell Infiltrates Entrapping Benign Gastric Glands (H&E stain, 40x).

Clinical characteristics and survival of lung cancer patients associated with multiple primary malignancies.

ObjectivesTo investigate the characteristics and survival of lung cancer patients with additional malignant primary cancers.MethodsRecords of lung cancer patients newly diagnosed in Shanghai Pulmonary Hospital between January 2000 and January 2010 were retrospectively reviewed. Patients with second primary lung cancer and those with lung cancer only were included for detailed analysis.ResultsOf 27642 newly diagnosed lung cancer patients, 283 patients (1.02%) suffered previous additional primary cancers. Compared with single primary lung cancer, patients with secondary lung cancer associated other primary cancers were more often women (female to male ratio 1:1.72 vs 1:2.58, P = 0.018), older (64.2 vs 60.5 years old, P<0.001), more squamous cell type (30.7% vs 20.5%, P = 0.004), less small cell (3.9% vs 15.5%, P<0.001) type, at earlier stages (17.7% vs 11.0% for stage I, P = 0.014), and more frequently with family history of cancers (7.8% vs 3.9%, P = 0.038). The most common previous primary cancers observed were colorectal (22.0%), breast (18.4%), gastric (14.4%) and larynx cancers (11.9%). Approximately 42.9% of patients were diagnosed with lung cancer 2 to 6 years after diagnosis of initial primary cancers. The survival of patients with secondary lung cancer associated other malignancies was not significantly different from those with single lung cancer (P = 0.491), while synchronous multiple primary malignancies showed worse prognosis compared with those with metachronous ones or single lung cancer (p = 0.012).ConclusionThe possibility of second primary lung cancer should always be considered during the follow-up of related cancer types, especially those with family history of cancers. Patients with secondary lung cancer associated other primary malignancies have non-inferior survival than those with single lung cancer.

Clinicopathological parameters affecting nodal yields in patients with oral squamous cell carcinoma receiving selective neck dissection

IntroductionNodal yield has been demonstrated as a very promising marker for the prognostic outcome of patients with oral squamous cell carcinoma. However, studies on the importance of clinicopathological factors affecting the number of resected lymph nodes are rare, especially for patients without pathologically proven cervical lymph nodes. Material and methodsRetrospective chart review of 264 patients with treatment naive oral squamous cell carcinoma and histopathologically proven negative cervical lymph node status, who received selective neck dissection of levels I-III/IV. Exclusion criteria were neoadjuvant chemoradiotherapy, comprehensive or bilateral neck dissection, T4b classification, perioperative death, unresectable disease, synchronous malignancy, follow-up <3 months and inadequate information to correctly determine nodal yield. Statistical analysis was performed by using univariate and multivariate analysis. ResultsThe mean nodal yield was 22.31 with a standard deviation of 16.01 and a mean number of 17 nodes. Gender (p = 0.018), age (p = 0.03), tumor classification (p < 0.001) and perineural invasion (p = 0.012) were significantly associated with nodal yield. Multivariate analysis indicated T-classification (p = 0.049) and age (p = 0.020) as independent factors. Nodal yield was significantly associated with locoregional recurrence (p = 0.041; Cutoff value = 17). ConclusionAdvanced age and T-classification independently affect lymph node yields in patients with oral squamous cell carcinoma. Hence, they have to be considered for interpretation of both nodal yield and recommended minimum lymph node counts. Furthermore, resection of more than 17 lymph nodes is associated with a significantly lower risk of locoregional recurrence.

The characteristics of breast cancer patients with metachronous primary malignancies

Introduction. The risk of developing subsequent primary cancers varies from 1% to 18% and it depends on the type of first cancer and treatment methods applied. Considering the time of occurrence, multiple primary cancers generally fall into two categories: synchronous and metachronous. In breast cancer patients, 10.5% developed multiple primary cancers, from which 23.8% had synchronous, 79% had metachronous and the remaining 2.8% had both synchronous and metachronous malignancies. In patients with breast cancer, elevated risk is observed especially in the development of contralateral breast cancer, endometrial cancer, esophageal cancer, ovarian cancer and thyroid cancer. Aim. This paper presented the characteristics of breast cancer patients with metachronous primary malignancies in relation to the type of metachronous primaries (breast versus non-breast) and to analyse the impact of the type of metachronous cancers on survival rate. Material and methods. Among patients treated for breast cancer between 1963 and 2010, 354 patients (2.1%) developed metachronous primary malignancies and these made up 13.8% of all patients with multiple primary cancers. The mean age at diagnosis of the first breast cancer was 53 ± 11.5 years; positive family cancer history was noted in 127 patients (35.9%). Metachronous malignancies are defined as primaries following the diagnosis of breast cancer in a time interval greater than or equal to than 6 months. In our group, the mean time interval between the diagnosis of breast cancer and the appearance of metachronous malignancies was 100.9 ± 74.9 months (range: 6–543 months, median: 83 months). For comparison of the two groups (patients with second breast vs non-breast cancer) we used the Pearson’s Chi-square test for independence (for categorized variables) and variance analysis with Student’s t-test (for continuous variables). The survival rate was evaluated with the Kaplan-Meier method, and the log rank test was applied to assess the influ­ence of some factors on the evaluated results. The significance level at α = 0.05 was adopted for all statistical analyses. Results. The probability of occurrence of new cancer averaged from 38.1% to 67.8% for 5 and 10 years after diagnosis of first breast cancer, respectively. In our group, 380 cases of metachronous carcinomas were noted in 354 analysed patients. The most frequent metachronous malignancy was breast cancer (194 cases — 54.8%), which occurred as second (192 cases) or third (2 cases) cancer. Patients with contralateral breast cancer in comparison to other types of metachronous malignancies were significantly (p &lt; 0.05): younger (under 50 years: 56.2% vs 34.4%), premenopausal (69.6% vs 48.8%), had a lobular type of first breast cancer (6.7% vs 1.3%), and rarely received tamoxifen (25.3% vs 48.2%). The type of me­tachronous cancers significantly influenced survival rate: 10-year overall survival rates were 80.1% vs 67.8%, (p = 0.0271). Conclusions. The risk of occurrence of second malignancies in breast cancer survivors makes early detection of metachronous malignancies obligatory because it is an important factor which influences the quality of life in breast cancer survivors.

Case Report: Synchronous primary malignancy including the breast and endometrium.

Breast and endometrial cancer are the most common types of female cancers, but the incidence of both of these malignancies in a single patient is a rare event. Multiple primary malignancy has been increasingly reported over the past decade, and double primary cancer is considered as the most common type. In this study, we present a 53-year-old woman with synchronous primary malignancy of breast and endometrium. This patient had a history of breast and endometrial cancer in her family. Mammography and chest CT of the patient revealed a mass in the right breast and left supraclavicular region. However, the patient did not want to initiate treatment. Subsequently, the patient returned with a chief complaint of persistent abnormal vaginal bleeding. Abdominopelvic CT scan of the patient revealed a huge soft tissue mass in the pelvic cavity. She underwent hysterectomy, and pathology revealed endometrioid carcinoma, which had invaded the full thickness of uterine wall. Since this type of malignancy is rare and several risk factors are associated with it, it is worth being considered by clinicians when making decisions about screening or strategy for prevention.

The importance of log odds of positive lymph nodes for locoregional recurrence in oral squamous cell carcinoma

ObjectivesLog odds of positive lymph nodes (LODDS) has been demonstrated as a very promising staging model for multiple cancer sites, as it avoids singularity and predicts prognosis significantly better than conventional nodal staging and lymph node ratio. However, published studies on the influence of LODDS for patients with OSCC are very seldom. Material and methodsRetrospective chart review of 499 patients with treatment-naive oral squamous cell carcinoma. Exclusion criteria were neoadjuvant chemoradiotherapy, T4b classification, perioperative death, unresectable disease, synchronous malignancy, follow-up < 3 months and inadequate information to correctly determine nodal yield. Statistical analysis was performed using univariate and multivariate analysis. ResultsA significant correlation was found between locoregional recurrence and pathologic T classification (p=0.030), pathologic N classification p=0.013), extracapsular spread (p=0.034), grading (p=0.021), number of positive lymph nodes (p=0.042), lymph node ratio (p=0.009), LODDS (p=0.007) and treatment strategy (p=0.039). Multivariate analysis indicated lymph node ratio (p=0.029) and LODDS (p=0.015) as independent indicators for locoregional recurrence. Within the analyzed models, Nagelkerke R2 index and Someŕs D showed the strongest discrimination ability for LODDS. ConclusionFor patients with oral squamous cell carcinoma, log odds of positive lymph nodes and lymph node ratio are independent indicators for locoregional recurrence. LODDS predicts locoregional recurrence better than conventional nodal staging system, lymph node ratio and the number of positive lymph nodes.

Surgical Management of Patients with Neuroendocrine Neoplasms of the Appendix: Appendectomy or More

Background: Appendiceal neuroendocrine neoplasms (ANEN) are mostly indolent tumours treated effectively with simple appendectomy. However, controversy exists regarding the necessity of oncologic right hemicolectomy (RH) in patients with histologic features suggestive of more aggressive disease. We assess the effects of current guidelines in selecting the surgical strategy (appendectomy or RH) for the management of ANEN. Methods/Aims: This is a retrospective review of all ANEN cases treated over a 14-year period at 3 referral centres and their management according to consensus guidelines of the European and the North American Neuroendocrine Tumor Societies (ENETS and NANETS, respectively). The operation performed, the tumour stage and grade, the extent of residual disease, and the follow-up outcomes were evaluated. Results: Of 14,850 patients who had appendectomies, 215 (1.45%) had histologically confirmed ANEN. Four patients had synchronous non-ANEN malignancies. One hundred and ninety-three patients had index appendectomy. Seventeen patients (7.9%) had lymph node metastases within the mesoappendix. Forty-nine patients underwent RH after appendectomy. The percentages of 30-day morbidity and mortality after RH were 2 and 0%, respectively. Twelve patients (24.5%) receiving completion RH were found to have lymph node metastases. Two patients had liver metastases, both of them synchronous. The median follow-up was 38.5 months (range 1-143). No patient developed disease recurrence. Five- and 10-year overall survival for all patients with ANEN as the only malignancy was both 99.05%. Conclusions: The current guidelines appear effective in identifying ANEN patients at risk of harbouring nodal disease, but they question the oncological relevance of ANEN lymph node metastases. RH might present an overtreatment for a number of patients with ANEN.

Triple synchronous primary malignancies: a rare occurrence

Triple synchronous primary malignant neoplasms are rare. The exact aetiology is unknown; however, risk factors include older age, family history, genetic aberrations, prolonged exposure to carcinogens and smoking. We describe...

Detection of Synchronous Primary Malignancies with 68Ga-Labeled Prostate-Specific Membrane Antigen PET/CT in Patients with Prostate Cancer: Frequency in 764 Patients.

We evaluated the incidence of synchronous primary malignancies in patients undergoing 68Ga-labeled prostate-specific membrane antigen PET/CT for prostate cancer (PC). Methods: Reports for 764 PC patients were reviewed. Incidental lesions atypical for PC metastases and suggestive of a synchronous primary malignancy were identified. Follow-up was obtained to confirm etiology. Results: Lesions atypical for PC metastases were found in 49 (6.4%) of 764 patients, and a synchronous primary malignancy was confirmed in 5 patients (0.7%; 2 lung, 1 lymphoma, 1 thyroid, and 1 base of tongue). In 8 patients (1.0%), lesions were proven to be atypical metastases from PC. In 24 patients (3.1%), lesions had a benign etiology. Follow-up was not available in 12 patients (1.6%). Conclusion: Synchronous 68Ga-labeled prostate-specific membrane antigen-avid malignancies were rare (0.7%) in PC patients; atypical lesions were more commonly unusual PC metastases (1.0%) or benign (3.1%).