Synchronous Malignancies Research Articles

Retrospective analysis of the role of CA 15-3 as a biomarker for breast cancer relapse.

e23051 Background: The latest ASCO guidelines regarding tumor markers in breast cancer do not recommend routine monitoring of serum CA 15-3 (CA) levels alone as a marker for relapse. They do, however, acknowledge their use in conjunction with a patient’s history, physical exam, and diagnostic imaging. The study objective is to evaluate CA as a marker for relapse and determine its continued use in our patient population. Methods: We performed a retrospective analysis on female stage I-III breast cancer patients with an elevated CA marker treated in our cancer center between 2009-2014. Patients with metachronous or synchronous malignancies were excluded. Patients were categorized into three groups: Group 1 (elevated CA at relapse), Group 2 (normal CA at relapse, with elevation post-relapse), Group 3 (elevated CA without relapse). Categorical variables were collected to fulfill our objectives and the Fisher’s exact test was used to assess the correlation between them. The incidence rate and its 95% confidence interval were estimated based on the binomial distribution. Results: Out of 340 initially screened patients, 92 met our inclusion criteria: Group 1 (n = 25), Group 2 (n = 23), Group 3 (n = 44). The PPV for an elevated CA as a marker for relapse was 36% (95% CI: 26-48%). On routine surveillance, patients with elevated CA levels were more likely to have relapse if they presented with nausea (p = 0.02), myalgia (p = 0.003), or axial bone pain (p = 0.04). At relapse, an elevated CA was associated with fatigue (p = 0.02), myalgia (p = 0.01), liver metastases (p = 0.01), axial bone metastases (p = 0.005), and peripheral bone metastases (p = 0.0002). In patients with an elevated CA, a BMI < 25 had a higher incidence of relapse in comparison to those with a BMI ≥ 25 (p = 0.01). Conclusions: Our study suggests that a patient’s history, physical, and symptom-dictated imaging should be the main way to screen for relapse in stage I-III breast cancer. Based on the higher incidence of relapse in patients with both an elevated CA and symptoms of nausea, myalgia, or axial bone pain, we conclude that serum CA levels may be used as an adjunctive test in symptomatic patients. Our data also suggests that elevated CA levels may be less useful in detecting relapse in patients with BMI ≥ 25.

The importance of lymph node ratio for locoregional recurrence of squamous cell carcinoma of the tongue

IntroductionLocoregional recurrence plays a key role in treatment failure of patients with squamous cell carcinoma of the tongue. In a large amount of studies lymph node ratio could be demonstrated as a promising parameter to stratify risk of patients with oral cavity cancer. However data on the influence of lymph node ratio on locoregional recurrence of tongue squamous cell carcinoma is very rare. Material and methodsRetrospective chart review of 130 patients with treatment naive squamous cell carcinoma of the tongue. Exclusion criteria were neoadjuvant chemoradiotherapy, perioperative death, N3 disease, unresectable disease, synchronous malignancy, follow up <3 months. Contingency tables and χ2-test were performed to analyze associations between clinicopathological features and recurrence. All statistic were 2-sided and a p-value <0.05 was considered as significant. Multivariate analysis was performed using binary logistic regression analysis. A cut off value of 6% for lymph node ratio was applied. ResultsSignificant correlations were found between locoregional recurrence and pathologic N-Classification (<0.001), UICC stage (<0.001), perineural invasion (p = 0.025), grading (p = 0.001), number of resected lymph nodes (p = 0.007) and lymph node ratio (p < 0.001). Multivariate analysis indicated lymph node ratio as solely independent risk factor for locoregional recurrence. ConclusionsLymph node ratio may be an useful parameter to stratify risk of locoregional recurrence of patients with squamous cell carcinoma of the tongue. Thus lymph node ratio might help to improve diagnosis and therapy of affected patients.

Two synchronous malignant tumors of the pancreas: a case report

BackgroundOnly a limited number of multiple synchronous primary malignancies of the pancreas have been reported in the medical literature. We report a case of two solid malignant tumors of the pancreas diagnosed preoperatively.Case presentationWe describe a 65-year-old Sri Lankan woman who presented with progressive obstructive jaundice. Initial contrast-enhanced computed tomography imaging detected a malignant tumor at the tail of her pancreas. A second tumor of the pancreatic head was detected with integrated imaging using multidetector computed tomography and multimodal magnetic resonance imaging. She underwent total pancreaticoduodenectomy and splenectomy. Gross examination of the specimen confirmed the presence of two separate tumors. Histology of the ampullary tumor showed pancreatic-type adenocarcinoma and the tumor in the tail of her pancreas showed a colloid-type adenocarcinoma. ConclusionThe possibility of multiple primary malignant solid tumors of different types with malignant potential has to be considered even without background pathology when managing multiple tumors in the pancreas.

Synchronous Primary Carcinoma of Cervix and Endometrium

Introduction: Synchronous primary tumours in the female genital tract are rare. Even rarer are the synchronous tumours involving the cervix and endometrium . We describe a rare case of cervical squamous cell carcinoma and endometrial endometrioid adenocarcinoma in a 62-year-old woman . Case report A 62-year-old female presented with post menopausal bleeding for 4 months duration. Per vaginal examination showed a cervical growth . Magnetic resonance imaging revealed a mass in the cervical region and extension into the body and fundus of the uterine cavity. Radical hysterectomy(Type III hysterectomy) was done. The pathology revealed synchronous occurrence of primary neoplasms of squamous cell carcinoma of the cervix and adenocarcinoma of the endometrium. Conclusion Synchronous malignancies of endometrium and cervix are rare. Surgical treatment is radical surgery- Type 3 hysterectomy with bilateral pelvic lymph node dissection. The knowledge of occurrence of synchronous primaries is needed to plan appropriate adjuvant treatment. DOI: 10.21276/APALM.1073

Synchronous primary malignant neoplasms of the cervix and endometrium

Synchronous multiple malignant neoplasms of the female genital tract are rare, particularly in the uterus. We herein present the case of a patient with synchronous cervical squamous epithelial carcinoma and endometrial adenocarcinoma, and discuss the diagnosis, treatment and prognosis. The patient underwent a cervical biopsy and fractional curettage of the endometrium, followed by abdominal staging surgery, including radical hysterectomy, bilateral salpingo-oophorectomy, pelvic and para-aortic lymphadenectomy. The diagnosis was stage Ib1 cervical cancer and stage Ia endometrial cancer, without lymph node metastases. There has been no recurrence during 1 year of followup. Synchronous genital tract neoplasms are more clinically complex compared with single neoplasms and it is crucial to focus on the differential diagnosis between primary and metastatic tumors during the diagnostic process. The treatment of synchronous genital tract neoplasms also differs significantly from that of single neoplasms, although the prognosis of patients with synchronous gynecological malignancies does not appear to be worse.

Synchronous primary malignancy of ovary and cervix- the rare co-passengers

Background Synchronous genital tract malignancies are rare with overall incidence of synchronous primary malignancies of the female genital tract being 0.63%.

Noninvasive Encapsulated Follicular Variant of Papillary Thyroid Cancer: Clinical Lessons from a Community-Based Endocrine Surgical Practice.

Objective. Retrospective studies have found that noninvasive encapsulated follicular variant of papillary thyroid cancer (EFVPTC) exhibits highly indolent clinical behavior. We studied the clinical features of our patients with noninvasive EFVPTC tumors culled from a community endocrine surgical practice registry over the past four years. Methods. We interrogated the Memorial Center for Integrative Endocrine Surgery (MCIES) Registry for all recorded encapsulated follicular variant of papillary cancer pathologic diagnoses. We identified a subgroup of patients without capsular or vascular invasion and studied their clinical characteristics. Results. Thirty-seven patients met inclusion and exclusion criteria. The typical patient was young and female. Nodules averaged 3.1 cm in greatest dimension by ultrasound evaluation. Thirteen patients were found to have synchronous malignancies elsewhere in the thyroid (35%). At the time of this writing, we have not seen a clinical recurrence in any of our 37 noninvasive EFVPTC patients. Conclusions. Early clinical follow-up data suggests that the majority of noninvasive EFVPTC tumors exhibit indolent behavior, but clinical decision-making with regard to completion thyroidectomy, central lymph node dissection, and adjunctive radioiodine therapy often depends on the amount and type of synchronous thyroid cancer detected elsewhere in the thyroid gland and the central neck.

Synchronous dual malignancy of papillary carcinoma thyroid and squamous cell carcinoma tongue: A case report

Synchronous dual malignancy of papillary carcinoma thyroid and squamous cell carcinoma tongue: A case report

Clinicopathologic Comparison of Plasmablastic Lymphoma in HIV-Positive Versus HIV-Negative Patients: Single-Center Experience

Background: Plasmablastic lymphoma (PBL) is an aggressive lymphoma associated mainly to HIV infection, although cases in immunocompetent patients are described as well.Objective: To describe the prevalence, the clinicopathologic features and determine the overall survival of lymphoma patients according human immunodeficiency virus (HIV) status.Methods: We reviewed the pathology database at Instituto Nacional de Enfermedades Neoplasicas (INEN), the leading cancer center of Peru from 2005 to 2014. 6218 cases were lymphomas, 5031 cases were Non-Hodgkin lymphoma and 3905 cases were B-cell lineage. 22 met diagnosis of PBL, 4 patients were excluded (1 prior treatment, 1 synchronous malignancy and 2 incomplete medical records). Finally, we had 18 cases for evaluation. Survival curves were estimated by Kaplan Meier. Statistical analysis was based on SPSS Program version 22.Results: The prevalence of PBL was 0.004% of all Non-Hodgkin lymphomas and 0.005% of B-cell lymphomas. 13 of 18 cases (72.2%) were HIV-positive patients (PBL-HIV+). The median age for PBL-HIV+ was 37 years (range 22-67 years) and 58 years (range 53-74 years) for HIV-negative patients (PBL-HIV-).The extra-oral primary was the most frequent primary site in both groups. The advanced stage was 80% in PBL-HIV- patients. Presence of B-symptoms and Ki-67>80% were greater in PBL-HIV- patients. CHOP or CHOP-like regimen was the common treatment in both groups, only one patient received DA-EPOCH (PBL-HIV+ group). HAART-naïve patients were 77%. The median OS time was 43 months (range 1-84 months) in PBL-HIV+ patients and 13 months (range 0-15 months) in PBL-VIH- patients, the 5-yrs-OS was 26.9% y 0% respectively.Conclusions: Plasmablastic lymphoma is a rare lymphoma, either associated or not to HIV infection. Advanced and aggressive disease is a distinctive feature in both lymphomas. The PBL-HIV- has a worse prognosis with shorter overall survival compared to the PBL-HIV+ patients. DisclosuresNo relevant conflicts of interest to declare.

Characterization and Management of Synchronous Dual Hematological Malignancies

Background: Patients with a single hematological malignancy (SHM) may be unexpectedly diagnosed with a synchronous dual hematological malignancy (SDHM). Management of such patients is challenging and the impact of therapy on the secondary malignancy is often unknown.Methods: We reviewed 3036 patients followed in our center from February 2013 to July 2016. Using WHO 2008 criteria we excluded closely-related diseases (e.g. transformed lymphoma, myeloma arising from monoclonal gammopathy of unknown significance (MGUS), lymphoproliferative disorders with associated paraproteins) and included only clonally unrelated SDHMs.Results: We identified 41 patients with SDHM, a prevalence of 1.35%. Median age was 75 years (range 23-90), with male predominance (26 male, 15 female). All patients were Caucasians except 1 African, and 38/41 were diagnosed locally. Thirteen patients (31.7%) had concomitant solid cancers. Referrals from family practitioners/hospitalists were of two types: 65% with a general diagnosis and 35% with non-specific symptoms requiring work-up. Referrals from specialists (internal medicine or hematology) were more accurate; only asymptomatic secondary diagnoses were missed. SDHMs were diagnosed either incidentally during routine work-up, or because discordant clinical/laboratory findings did not fit a single diagnosis.Three combinations of SDHMs were identified (Table 1). In the Myeloid+Lymphoid group, concomitant MGUS was most frequent. Within the Lymphoid+Lymphoid group, SDHM combinations were random. There were only 3 Myeloid+Myeloid SDHMs. Twenty-nine patients (70.7%) required initiation of therapy for primary malignancy and 12 (29.3%) were on active surveillance. For secondary diagnosis, 29 (70.7%) patients were actively monitored, and 12 (29.3%) needed treatment (9 simultaneously, 3 delayed). At the completion of treatment for primary malignancy, 37 (90.2%) were either in remission or have non-progressing disease, 4 patients progressed. At the time of data cut-off, 34 patients (82.9%) were alive, compared to 87.2% of patients with SHM. Seven patients died, 3 from disease progression, and 4 from unrelated health issues.Our management experience of SDHM is following:- Have low threshold for intensive investigations if there are discordant data- Patients with low-grade/low-acuity SDHM can be managed safely by active surveillance, with early re-evaluation of both diseases if conditions change- If two malignancies require treatment, therapy should be aimed at the more aggressive one- ABVD chemotherapy completely resolved cutaneous T-cell lymphoma lesions- Cladribine, 6 cycles, had no effect on concomitant chronic myelomonocytic leukemia (CMML)- Ruxolitinib either precipitated chronic lymphocytic leukemia from B-cell lymphocytosis or accelerated progression- Hydroxyurea decreased M-spikes in MGUS, regardless of type- Azacitidine given for CMML positively affected mast cell leukemia and was associated with reduction of bone marrow fibrosis, but had no effect on follicular lymphoma- Phlebotomized patients with polycythemia vera may develop profound anemia on chemotherapy. We recommend holding phlebotomies and replacing iron stores intravenously. Temporary therapy with erythropoietin-stimulating agents or red cell transfusions may be needed.Conclusions: SDHMs are not uncommon and require careful investigation if the primary diagnosis is not clear. Myeloid+Lymphoid and Lymphoid+Lymphoid combinations are most common. The high frequency of concomitant solid tumors suggests increased susceptibility to SDHM or impaired immunity. Many second hematological malignancies can be managed by regular monitoring. Active treatment of SDHM requires special considerations. Our recommendations are limited by small patient numbers and a single center. Further studies of SDHM, exploring different cohorts and ethnicities, are needed. [Display omitted] DisclosuresNay:Gilead Sciences, Inc.: Honoraria; Janssen: Honoraria, Other: Advisory board; Celgene: Honoraria, Other: Advisory board; Amgen: Other: Advisory board; Lyndbeck: Honoraria; BMS: Honoraria.

Synchronous Primary Malignancies of the Kidney and Colon: A Rare Case

The coexistent diagnosis of colorectal cancer and renal cell carcinoma is rare. We reported a 55-year-old woman with history of recurrent UTI, who was admitted to Urology Clinic with left flank pain for the evaluation of renal stone. Ultrasound examination revealed a homogenous mass measuring 4.7cm with a calcified focus in left kidney. Macroscopic evaluation revealed a renal mass in lower pole, 5cm in maximum diameter with variegated cut surface. The pathology report showed clear cell carcinoma of kidney. The patient had a colonoscopy report of many polyps in the entire length of colon with a clinical impression of familial adenomatous polyposis since last year but with no genetic confirmatory tests Since last year, the pathology report showed well differentiated adenocarcinoma of colon invading to submucosa with no vascular and perineural invasion in the distal margin of colon. In family history, her passed brother had colon cancer and her sister was alive with colon cancer that had a colostomy. In summary, the existence of both kidney and colon cancers occurs more in elderly patients. Also, the existence of colon adenocarcinoma with numerous polyps can be a risk factor for the second malignancy that the physicians must pay attention to this point in their follow-up.

Solid-Pseudopapillary neoplasm of the pancreas: A clinicopathological review of 20 cases including rare examples

AimsSolid-pseudopapillary neoplasm (SPN) is an uncommon malignant tumor of the pancreas with a favorable prognosis unlike other pancreatic neoplasms. We investigated the clinicopathological features of 20 patients with SPN in details. MethodsThe patients diagnosed as SPN in Dokuz Eylul University Hospital between January 2005 and March 2016 were reviewed in terms of clinical and histopathological data. ResultsMean age of the patients was 33. Three of our cases were male and 4 were children. Some patients had synchronuous malignancies. Nine patients were diagnosed by fine needle aspiration cytology (FNAC). One of our tumors had 2×1mm of pancreas endocrine neoplasm in addition to SPN. One case had foci of atypical and multinucleated giant cells. All cases were positive for vimentin and CD10 antibodies and most were positive for PR and β-catenin. The mean follow-up duration was 40 mo (range 2–110 mo). Only one case showed liver metastasis. ConclusionHerein we present a series of 20 patients with 3 male and 4 pediatric cases, almost half of which were diagnosed with FNAC findings, and most of which are clinically being followed with one patient showing progression. Our series includes rare examples like collision tumor of SPN and pancreas endocrine neoplasm, SPN with multinucleated giant cells. Also cases with no surgical treatment and no progression, as well as cases with synchronous malignancies are presented. We believe that FNAC findings of any pancreatic mass should be investigated in detail for the designation of a therapy plan especially for the patients with high operation risks. The findings in our series also show that extensive necrosis, angioinvasion, perineurial invasion and larger tumor size might be predictive for worse prognosis and these patients should be more closely followed up.

Clinical outcome in lung cancer with a second malignancy: The time sequence matters.

The aim of the study was to determine the clinical outcome of lung cancer patients with a secondary malignancy according to the time sequence between the lung cancer and the secondary malignancy.Retrospective review of all lung cancer patients with any secondary cancer treated from June 2004 to July 2012. The survival of patients with a secondary malignancy was compared to those patients without a secondary malignancy. According to the time sequence between the lung cancer and the secondary malignancy, patients were divided into 4 groups. Group I: lung cancer without any other malignancy, Group II: lung cancer with a secondary malignancy at follow-up, Group III: lung cancer with a pre-existing malignancy, Group IV: synchronous malignancies (diagnosis interval between lung cancer and a secondary malignancy of less than 3 months).Patients with any secondary cancer in their history or at follow up included 157 patients (9.5%). Collectively; the median survival was significantly better for patients with a secondary malignancy, 19.09 months, compared to those without a secondary malignancy, 9.53 months, P < 0.001, HR 0.66 (95% CI 0.55 – 0.79). However, the survival differed significantly according to the time sequence between the lung cancer and the secondary malignancy. The median survival was 47.9 months for group II patients, 12.19 months for group III, 17.51 months for group IV, and 9.53 months for group I; P = 0.001. In Cox proportional hazard analysis, the risk of dying decreased by 68% in group II patients compared to group I patients, HR 0.32 (95% CI 0.21–0.5), P < 0.001. Although the risk of dying for group III and IV decreased by 19% and 16% respectively compared to group I patients, it did not reach statistical significance.Nowadays, secondary malignancy in lung cancer patients is a frequent finding. Better survival was observed for patient with secondary malignancy following lung cancer.

Concurrent Chemoradiation Therapy for Esophageal Cancer and Synchronous Second Primary Malignancy in the Upper Digestive Tract

Concurrent Chemoradiation Therapy for Esophageal Cancer and Synchronous Second Primary Malignancy in the Upper Digestive Tract

Multifocality and Bilaterality of Lobular Carcinoma In Situ in Women with Synchronous Breast Malignancies

Introduction: Historical studies have reported a wide range of multifocality (50-80%) and bilaterality (9-69%) for lobular carcinoma in situ (LCIS), yet there is limited prospective data on distribution of LCIS in relation to synchronous in-breast malignancies. We report multifocality/bilaterality rates of LCIS diagnosed synchronously with ductal carcinoma in situ (DCIS), invasive lobular carcinoma (ILC), and invasive ductal carcinoma (IDC). Methods: Patients with biopsy-proven …

Synchronous double primary renal cell carcinoma and duodenal adenocarcinoma

As a result of development in medical diagnostic technology, the incidence of double primary cancer is increasing. In case that one primary cancer was identified by pathologic finding and has suggestive multiple metastatic lesions of the cancer, it is often difficult that the lesions are considered as another synchronous primary malignancy, not as metastasis of primary cancer. Here, we report a rare case of synchronous double primary renal cell carcinoma that was diagnosed initially as metastatic duodenal adenocarcinoma. A 66-year-old man presented with a palpable abdominal mass. Abdominal computed tomography showed duodenal wall thickening and hypervascular masses in the liver and left kidney. Esophagogastroduodenoscopy revealed an ulcerative lesion in the duodenal bulb, and endoscopic biopsy identified moderately-differentiated adenocarcinoma. We regarded the findings as duodenal adenocarcinoma with metastasis to liver and kidney. So he was treated with fluoropyrimidine-based chemotherapy for the diagnosis of duodenal adenocarcinoma with liver and renal metastases. After 10 months, he developed a right forearm mass. Morphological and immunohistochemical analysis of an incisional biopsy of the forearm mass were consistent with a diagnosis of metastatic renal cell carcinoma. Even when there is a pathologically confirmed malignancy, clinicians must consider the possibility of synchronous double primary malignancy in metastatic lesions.

Meta-analysis of Outcomes Following Aneurysm Repair in Patients with Synchronous Intra-abdominal Malignancy

The management of concomitant intra-abdominal malignancy (IAM) and abdominal aortic aneurysm (AAA) remains a challenge, even though malignancy is common in an elderly population. By means of systematic review and meta-analysis, the aim was to investigate outcomes in patients undergoing open (OAR) or endovascular AAA repair (EVAR) that have a concomitant malignancy. A systematic literature review was performed (Medline and EMBASE databases) to identify all series reporting outcomes of AAA repair (OAR or EVAR) in patients with concomitant IAM. Meta-analysis was applied to assess mortality and major morbidity at 30 days and long term. The literature review identified 36 series (543 patients) and the majority (18 series) reported on patients with colorectal malignancy and AAA. Mean weighted mortality for OAR at 30 days was 11% (95% CI: 6.6% to 17.9%); none of the EVAR patients died peri-operatively. The weighted 30-day major complication rate for EVAR was 20.4% (10.0-37.4%) and for OAR it was 15.4% (7.0-30.8%). Most patients had their AAA and malignancy treated non-simultaneously (56.6%, 95% CI, 42.1-70.1%). In the EVAR cohort, three patients (4.6%) died at last follow-up (range 24-64 months). In the OAR cohort 23 (10.6%) had died at last follow up (range from 4 to 73 months). In this meta-analysis, OAR was associated with significant peri-operative mortality in patients with an IAM. EVAR should be the first-line modality of AAA repair. The majority of patients were not treated simultaneously for the two pathologies, but further investigation is necessary to define the optimal timing for each procedure and malignancy.

Synchronous papillary urothelial carcinoma of the bladder and squamous cell carcinoma with sarcomatoid differentiation: A case report.

The incidence rate of multiple primary tumors is 37% in all types of cancer. A patient diagnosed with primary cancer is 1.29 times more likely to develop an additional primary cancer when compared with the general population. Furthermore, in patients diagnosed with primary cancer, the possibility of a secondary malignancy in the same or different organ is increased. Following the identification of a secondary tumor, the risk of relapse or metastasis must be considered. The present study reports the case of a 76-year-old man who was admitted to Sakarya University Training and Research Hospital (Sakarya, Turkey) with swelling of the head, which had been apparent for 15 days. An excisional biopsy of the temporal region was performed and was used to diagnose the patient with synchronous squamous cell carcinoma with sarcomatoid differentiation of the scalp. The patient was referred to the Department of Plastic Surgery (Sakarya University Training and Research Hospital) for resection; however, he refused treatment and was subsequently discharged. To the best of our knowledge, this patient represents the first case of synchronous skin malignancy and urothelial carcinoma of the bladder to be reported in the literature.

Screening not staging: a retrospective study of the rate of synchronous primary malignancy in 44 T1/T2 laryngeal cancer in a tertiary head and neck unit.

Screening not staging: a retrospective study of the rate of synchronous primary malignancy in 44 T1/T2 laryngeal cancer in a tertiary head and neck unit.

Synchronous Primary Carcinomas of Cervix and Ovary: A Case Report

Synchronous tumors occur rarely in female genital tract, though it is one among potential sites for synchronous malignancies. In our case report a 36 year old female is diagnosed with two primary malignancies simultaneously; squamous cell carcinoma cervix and bilateral papillary cystadenocarcinoma ovary. Their distinct histological features and sparing of uterine corpus and fallopian tube helped in establishing the diagnosis as two separate primaries rather as metastatic spread of one primary malignancy. The objective is to strengthen the suggestion of thorough evaluation of whole female genital tract in case of suspected tumor, as secondary Mullerian system theory explains the possibility of synchronous cancer in female genital tract.