Synchronous Malignancies Research Articles

Retrospective cohort study investigating association between precancerous gastric lesions and colorectal neoplasm risk.

Colorectal cancer (CRC) is considered the most prevalent synchronous malignancy in patients with gastric cancer. This large retrospective study aims to clarify correlations between gastric histopathology stages and risks of specific colorectal neoplasms, to optimize screening and reduce preventable CRC. Clinical data of 36,708 patients undergoing gastroscopy and colonoscopy from 2005-2022 were retrospectively analyzed. Correlations between gastric and colorectal histopathology were assessed by multivariate analysis. Outcomes of interest included non-adenomatous polyps (NAP), conventional adenomas (CAs), serrated polyps (SPs), and CRC. Statistical analysis used R version 4.0.4. Older age (≥50 years) and Helicobacter pylori infection (HPI) were associated with increased risks of conventional adenomas (CAs), serrated polyps (SPs), non-adenomatous polyps (NAP), and colorectal cancer (CRC). Moderate to severe intestinal metaplasia specifically increased risks of NAP and CAs by 1.17-fold (95% CI 1.05-1.3) and 1.19-fold (95% CI 1.09-1.31), respectively. For CRC risk, low-grade intraepithelial neoplasia increased risk by 1.41-fold (95% CI 1.08-1.84), while high-grade intraepithelial neoplasia (OR 3.76, 95% CI 2.25-6.29) and gastric cancer (OR 4.81, 95% CI 3.25-7.09) showed strong associations. More advanced gastric pathology was correlated with progressively higher risks of CRC. Precancerous gastric conditions are associated with increased colorectal neoplasm risk. Our findings can inform screening guidelines to target high-risk subgroups, advancing colorectal cancer prevention and reducing disease burden.

Clinico-Morphological Features and Immunohistochemical Profile of a Rare Case of Three Synchronous Primary Malignancies in the Female Genital Tract

(1) Background: Synchronous tumors are defined as tumors that occur at the same time, appearing within 2 months, according to the Surveillance Epidemiology and End Results Program, with a frequency of tertiary tumors of 0.5%. The purpose of this presentation is to report a case of three synchronous tumors of the female genital tract, given the fact that it represents a challenge both therapeutically and in demonstrating that the malignant lesions are completely different from each other. (2) Methods: We report the case of a 45 year-old patient diagnosed with three synchronous tumors developed in the genital tract: clear-cell ovarian carcinoma, uterine endometrioid adenocarcinoma, and cervical adenosquamous carcinoma. (3) Results: Total hysterectomy with bilateral anexectomy was performed and accompanied by a biopsy of the greater omentum. The evolution of the patient was favorable during chemotherapy, but she died two weeks after the completion of this treatment, from a cause secondary to the adverse effects determined by it, namely, severe thrombopenia which caused a massive lower digestive hemorrhage. (4) Conclusions: This case demonstrates the maximum importance of the involvement of adjuvant diagnostic techniques, especially when it comes to a diagnostic challenge with direct implications in the subsequent therapy of the patient.

Field Cancerization in Action; A Case of Synchronous Triple Primary Malignancies in the Head and Neck.

Field cancerization is the phenomenon that classically describes the occurrence of multiple primary malignancies in the head and neck subsites, either synchronous or metachronous. It's unusual to come across synchronous primaries, that too three at a time. Here is a patient who presented to us with triple primary squamous cell carcinomas involving the floor of the mouth, base of the tongue, and glottis at the same time…….

Primary carcinoma esophagus with unusual synchronous second malignancies: A case series

Multiple primary cancer is no longer a rarity. As life expectancy has increased, more individuals are living long enough to develop not only one but also two or more cancers. Herein, we report on three cases of synchronous malignancies associated with the primary esophagus cancer. All three patients posed a challenge for the treatment. These patients carry a dismal prognosis so early diagnosis of subsequent cancer at a curable stage by regular follow-up is encouraged. The early investigation of new symptoms and signs may help to diagnose, initiate early treatment, and reduce the number of deaths from subsequent primary cancers in patients.

Characterizations of uveal melanoma patients with three additional primary malignancies.

In a population-based cohort of 960 uveal melanoma (UM) patients, we describe patients with three additional malignancies, including one unique patient with four synchronous primary malignancies. A descriptive presentation of the clinical course and outcome for UM patients with three additional primary malignancies. After more than 20 years of follow-up of the UM cohort, 11 patients (1.1%) were diagnosed with three additional primary malignancies before, simultaneously or after UM. Among these, one patient had four synchronous primary malignancies, detected during workup for a symptomatic UM. All diagnoses were treated during the following 4 months, firstly the breast cancer, thereafter, the lung and pancreatic cancers and finally the UM. The patient died 3 years later of abdominal carcinomatosis due to the pancreatic cancer. The family history and gene testing did not disclose any genetic predisposition for cancer. A comparison of the four synchronous tumours, morphologically and immunohistochemically, showed no similarities and the expression of antibodies was different. Patients with UM may be diagnosed with non-ocular additional primary cancers. Thus, a comprehensive workup is obligatory and a further follow-up of the UM patients seems necessary. The UM is not always the main problem.

Comparison of Short-term and Long-term Outcomes after Different Reconstructions between Totally Laparoscopic Distal Gastrectomy and Laparoscopic-assisted Distal Gastrectomy for Gastric Cancer: a Retrospective Analysis at a High-volume Center.

Background: The short-term and long-term outcomes of laparoscopic-assisted distal gastrectomy (LADG) and totally laparoscopic distal gastrectomy (TLDG) have been subject to controversy with various reconstruction techniques of Billroth-I, Billroth-II, Roux-en-Y, and Uncut. This study aims to compare the short-term and long-term outcomes of LADG and TLDG as well as the outcomes of different anastomoses. Methods: This study enrolled patients with gastric cancer at the First Affiliated Hospital of Nanjing Medical University (NMUH) between 2017 and 2021. Postoperative complications were classified according to the Clavien-Dindo grade. Exclusion criteria included metachronous and synchronous malignancy and palliative surgery. The Kaplan-Meier analysis was applied to assess 5-year prognosis between two groups. Results: This study included 1221 cases with an overall complication rate of 17.37% for LADG, which was significantly higher than TLDG's 10.72%. The incidence of anastomosis-related complications was 4.79% for LADG and 1.13% lower for TLDG. LADG and TLDG did not show significant difference for Grade III-V complications and resected lymph nodes. The postoperative stay was shorter for TLDG than LADG, and R-Y had a longer postoperative stay than B-II and Uncut after combining LADG and TLDG. The operation time was shorter in TLDG cases than that in LADG cases. The 5-year OS of the TLDG group was not significantly better than that of the LADG group. Conclusion: TLDG is superior in overall complication rate, anastomosis-related complication rate, postoperative stay and operation time to LADG. No difference of OS was observed between LADG and TLDG. Four anastomoses had no convincing evidence of being superior in complications rates, post-op stay, and harvested lymph nodes to each other.

Comparison of immediate germline sequencing and multi-step screening for Lynch syndrome detection in high-risk endometrial and colorectal cancer patients.

Lynch syndrome (LS) is a hereditary cancer predisposition syndrome with a significantly increased risk of colorectal and endometrial cancers. Current standard practice involves universal screening for LS in patients with newly diagnosed colorectal or endometrial cancer using a multi-step screening protocol (MSP). However, MSP may not always accurately identify LS cases. To address this limitation, we compared the diagnostic performance of immediate germline sequencing (IGS) with MSP in a high-risk group. A total of 31 Taiwanese women with synchronous or metachronous endometrial and colorectal malignancies underwent MSP which included immunohistochemical staining of DNA mismatch repair (MMR) proteins, MLH1 promoter hypermethylation analysis, and germline sequencing to identify pathogenic variants. All patients who were excluded during MSP received germline sequencing for MMR genes to simulate IGS for the detection of LS. Our findings indicate that IGS surpassed MSP in terms of diagnostic yield (29.0% vs. 19.4%, respectively) and sensitivity (90% vs. 60%, respectively). Specifically, IGS successfully identified nine LS cases, which is 50% more than the number detected through MSP. Additionally, germline methylation analysis revealed one more LS case with constitutional MLH1 promoter hypermethylation, bringing the total LS cases to ten (32.3%). Intriguingly, we observed no significant differences in clinical characteristics or overall survival between patients with and without LS in our cohort. Our study suggests that IGS may potentially offer a more effective approach compared to MSP in identifying LS among high-risk patients. This advantage is evident when patients have been pre-selected utilizing specific clinical criteria.

An Unusual Case of Triple Synchronous Malignancies in a Middle-Aged Male Smoker: A Case Report and a Brief Literature Review.

The presence of multiple primary malignant tumors (MPMTs) in a single individual is unusual. Depending on when the tumors are diagnosed, they can be classified as synchronous or metachronous. In the literature, metachronous tumors are more frequently described than synchronous ones. The vast majority of synchronous tumor cases involve two primary tumors, usually located in the same anatomic location, such as the prostate and bladder; or esophagus and stomach – organs that have been subject to field cancerization. A triple synchronous tumor arising in different anatomical locations is extremely rare. We present a unique case of a middle-aged man with synchronous lung, esophageal, and renal cancers.

Synchronous or Metastatic Gastric and Ovarian Malignancies: A Diagnostic Challenge

Primary ovarian carcinoma is the prevailing form of cancer in the female reproductive system, leading to a substantial number of cancer-related fatalities globally. One of the major obstacles encountered in diagnosing this condition is distinguishing between primary gastrointestinal tumors and tumors that have metastasized from the ovaries, since they may exhibit similar histological characteristics. This case report underscores the difficulties involved in determining whether multiple tumors originate primarily or are a result of metastasis. We report a case of a 65-year-old female who presented with abdominal pain and was found to have a large multiloculated cystic mass in the right ovary and a poorly detected left ovary on ultrasound and CT scan. Her serum CA125 level was elevated. She underwent exploratory laparotomy and frozen section analysis of the right ovarian and gastric tumors. The histopathological diagnosis was mucinous cystadenocarcinoma of the ovary and well differentiated adenocarcinoma of the stomach. She also underwent hysterectomy with left salpingo-oophorectomy, which revealed mucinous cystadenocarcinoma of the left ovary. Immunohistochemical staining for specific markers, including CK7, CK20, CDX2, and PAX8, was conducted to identify the origin of the adenocarcinoma. The results revealed that both ovarian and gastric tumors showed a positive expression for CK7, while CK20 was negative in the gastric tumor but positive in the ovarian tumor. Furthermore, both CDX2 and PAX8 were negative in both the gastric and ovarian tumors. These findings provide valuable insights into the differential diagnosis and help to distinguish the possible sources of the adenocarcinoma. This case emphasizes the significance of histopathological examination and immunohistochemistry profiling in accurately diagnosing and determining the primary tumor site. Recognizing the primary tumor and its immunohistochemistry profile aids in guiding treatment strategies and predicting patient prognosis, leading to improved management and outcomes. Keywords Ovarian carcinoma, Gastric carcinoma, Immunohistochemistry

Pattern of Occurrence and Management of Dual Malignancy: Our Institutional Experience

Background: Management of dual malignancies is challenging in the present scenario of advanced techniques and increased life expectancy. Objectives: To determine the demographic and clinical profile of patients with dual malignancies and the management received. Methods: In this retrospective analysis of the data of patients presenting with histologically proven synchronous or metachronous dual malignancy, we evaluated the demographic and clinical profile of patients with dual malignancies and the management received. Results: In this study, 158 cases with multiple primary cancers, of whom 57 were synchronous and 101 were metachronous, were observed from January 2017 to December 2021. The maximum period for synchronous tumor occurrence was seen at 6 months (180 days). The interval of occurrence of metachronous tumors ranged from 1 to 15 years, with an average of 4.8 years for the entire group. Moreover, 73 (46.2%) were females, and 85 (53.8%) were males, with a male-to-female ratio of 1.2: 1. The most common site of primary tumor with dual malignancies was the head and neck (31%), followed by breast cancers (21%). The most frequent pathologic type was adenocarcinoma (40%), followed by squamous carcinoma (38%), hematopoietic and lymphoid tissues (7.5%), transitional cell carcinoma (6.3%), sarcomas and soft tissue tumors (2.5%). Conclusions: Even in complete clinical remission, every cancer patient must take into account the possibility of developing a second malignancy and must be closely monitored.

High Frequency of Mesenteric Panniculitis in Non-Hodgkin Lymphoma and Prostate Cancer: Study in 1,500 Oncologic Patients Undergoing Staging

To establish the frequency of MP in oncologic patients according to the type of cancer. Images of PET/CT performed between January 2008 and December 2019 on recently diagnosed oncologic patients were reviewed searching for MP. MP was defined as increased density and volume of mesenteric root fat, associated with nodules and/or lymph nodes, with or without pseudocapsule. Patients who had received previous cancer treatment or those with synchronous or metachronous malignancies were excluded. The frequency of MP in the total oncologic population was 5,3 % (82/1539). Types of cancer frequently associated with MP were non-Hodgkin lymphoma at 15,9% (31/195) and prostate cancer at 11,9% (16/134), both significantly higher than the rest of the malignancies (p < 0,01). Hodgkin Lymphoma (0/59), carcinoma of the cervix (0/45), and endometrial cancer (0/44) did not show MP. MP is more frequently associated with some malignant neoplasms, such as non-Hodgkin lymphoma and prostate cancer, and rare in others. This must be considered when studying patients with MP detected incidentally.

Synchronous Upper GIT Malignancy in an Elderly Patient

Previously thought that, synchronous colonic cancers are relatively common but synchronous upper gastrointestinal cancers are relatively uncommon. But now a days, frequency of synchronous esophageal cancers, gastric cancers or duodenal cancers is increasing due to availability of the upper GI endoscopy, and the prolonged life span of the general population. Here we discussed anelderly malewho presented with features of gastric outlet obstruction and dysphagia and finally diagnosed as simultaneous esophageal squamous cell carcinoma and gastric adenocarcinoma.&#x0D; Bangabandhu Sheikh Mujib Med. Coll. J. 2022;1(2):107-109

S2706 An Interesting Case of Synchronous Primary Malignancies in the Gastrointestinal Tract

S2706 An Interesting Case of Synchronous Primary Malignancies in the Gastrointestinal Tract

The Prognostic Impact of Substantial Lymphovascular Space Invasion in Women with FIGO Stage I Uterine Endometrioid Carcinoma with Pathologically Negative Nodal Evaluation

Substantiallymphovascular space invasion (LVSI) is an important predictor of lymph node involvement in women with endometrial carcinoma. However, its prognostic significance in women with stage I who had pathologic negative nodal evaluation (PNNE) was not fully evaluated. We aimed to evaluate the prognostic significance of substantial LVSI on recurrence-free (RFS), disease-specific (DSS) and overall survival (OS) in women with FIGO stage I uterine endometrioid adenocarcinoma (EC). Our uterine cancer database was queried for women with stage I EC who had a hysterectomy and PNNE at our institution between 1/1990 and 11/2022. Postoperatively, patients were managed with observation or adjuvant radiation therapy (RT) with pelvic external beam RT or vaginal cuff brachytherapy (VB). Women with synchronous malignancies and those who received adjuvant chemotherapy were excluded. Pathologic specimens were retrieved and LVSI was quantified by Gynecology pathologists (none, focal or substantial). Patients' demographics, surgical and pathologic variables were analyzed. Predictors of RFS, DSS and OS using univariate (UVA) and multivariate analysis (MVA) were studied. One thousand fifty-two patients were identified with a median age of 63 years and median follow-up of 9.7 years. Median number of examined lymph node (LN) were 9 (range 4-18). 907 patients (86.2%) had no LVSI, 87 (8.3%) had focal and 58 (5.5%) had substantial LVSI. In patients with focal LVSI, 32.2% received pelvic RT and 39.1% received VB. In patients with substantial LVSI, 20.7% received pelvic RT and 58.6% received VB.Recurrence was diagnosed in 86 patients (8.2%). While any LVSI was associated with tumor recurrence, there was no significant difference for the site of initial recurrence between patients with focal vs. substantial LVSI. 5-year RFS was 93.3% (95% CI 91.5-95.1), 76.8% (67.2-87.7) and 79.1% (67.6-95.3) for no, focal and substantial LVSI. The 5-year DSS was 97.6% (96.5-98.7), 83.5% (75-93.1), and 90% (81.8-99.9); and 5-year OS was 90.7% (88.7-92.8), 72.8% (62.9-84.2) and 86% (76.2-97.2), respectively. Independent predictors of worse 5-year RFS and DSS include any LVSI, age > 60 years, higher tumor grade. Independent predictors of worse 5- year OS include any LVSI, age > 60, high comorbidity burden, and higher tumor grade. Our large data suggest similar recurrence-free, disease specific and OS for women with stage I uterine endometrioid carcinoma who had pathologically negative nodal evaluation and substantial or focal LVSI. There was no significant difference for the site of initial recurrence between patients with focal or substantial LVSI. Multi-institutional pooled analyses may be needed to validate our results.

Minimally invasive treatment of multiple primary tumors of the gastrointestinal tract. Clinical observation

For now days we don’t have any guidelines for the treatment of synchronous and metachronous tumors of the upper and lower gastrointestinal tract. In this case report, we are talking about optimal treatment strategy in a patient with early gastric cancer, a neuroendocrine tumor of the sigmoid colon, and a locally advanced rectal cancer. The patient underwent laparoscopic gastrectomy and endoscopic excision of the early neuroendocrine tumor of the sigmoid colon. View of the local advanced rectal cancer patient underwent combined preoperative “sandwich” treatment with 2 courses of chemotherapy before a long course of chemoradiotherapy and 2 courses of chemotherapy after. The treatment was well tolerated. Ten weeks later, the patient gets surgical procedure: laparoscopic low anterior resection with loop colostomy followed by adjuvant chemotherapy. At the end of chemotherapy colostomy closure was done. The minimally invasive surgical treatment is safe and feasible in patients with synchronous malignancies of upper and lower gastrointestinal tract. Fast track rehabilitation and minimal surgical trauma ensure timely delivery of chemotherapy.

Paraneoplastic Polyarthritis in a Patient with Synchronous Lung and Colorectal Malignancy.

Arthritis is an unusual manifestation of paraneoplastic syndrome, appearing in a variety of cancers, including pulmonary and colorectal. It can often pose a diagnostic challenge to physicians, since it may be difficult to distinguish from more commonly encountered rheumatic illnesses. Moreover, synchronous cancers are rare and unexpected in patients with symmetrical polyarthritis. Hypertrophic pulmonary osteoarthropathy is to be considered in patients with polyarthritis and lung neoplasia. The aim of this report is to highlight the case of a patient presenting with paraneoplastic polyarthritis, which led to identifying the presence of underlying synchronous lung and colorectal malignancies. Lymph node biopsy was performed raising suspicion of Caplan's syndrome but lung lobectomy confirmed adenocarcinoma. Rheumatologists should be reacquainted with rheumatic manifestations in malignant diseases.

11C]Choline PET/CT in a Patient with Prostate Cancer Biochemical Recurrence Showing Two Suspicious Findings in the Breast and Liver.

A 79-year-old man with prostate cancer (PCa) was referred to our center to perform a [11C]Choline PET/CT for biochemical recurrence. Positron emission tomography/computed tomography (PET/CT) scan detected PCa recurrence in the prostate gland and several pelvic and abdominal lymph nodes. Two abnormal uptakes were also identified in the right breast and in the liver, respectively. Breast histological findings turned out to be gynecomastia, while the liver lesion resulted in a benign perfusion anomaly at follow-up magnetic resonance imaging (MRI). Although incidental findings were benign in this case, it is important to always investigate abnormal uptakes of [11C]Choline, as it could be an expression of further metastases or synchronous malignancies such as breast cancer and hepatocellular carcinoma.

The Incidence, Risk, and Overall Survival of First and Second Primary Head and Neck Malignancies in the Eastern Province, Saudi Arabia

Abstract Background: The mean survival time of head and neck cancers (HNC) differs according to patient and tumor characteristics. Treatment with radiotherapy or chemotherapy, genetic susceptibility, and environmental factors can contribute to the risk of developing second primary malignancy (SPM). Objective: Our purpose is to determine the rate of first primary malignancy and SPM among HNC patients, identify risk factors that may lead to the development of SPM, and analyze predictors of overall survival. Subjects and Methods: This is a single-center, retrospective study that included patients who were diagnosed with a head and neck and nonhead and neck SPM and visited the head and neck clinic between 2010 and 2020. Patients diagnosed with thyroid cancer or head and neck lymphoma, treated outside the facility, or lost to follow-up were excluded from the study. Data about demographics, diagnosis-related information, therapeutic approach, tumor recurrence, and the status of the patient and the tumor after the latest hospital visit were collected. Results: Thirty-seven (6.13%) cases were diagnosed with SPM with a median age of 61 years and a median time to diagnosis of 30.1 months from the first malignancy. Nearly half of the SPM patients were males (54.05%), smokers (51.35%), and underwent radiotherapy to treat the first cancer (51.35%). Laryngeal cancer carries the highest risk of the development of SPM of all SPM cases, followed by oral cavity cancers. The overall survival in patients with metachronous SPM is better than synchronous malignancies, with a median survival time of 149 months. Conclusion: The development of an SPM in patients with HNC is associated with decreased overall survival. Male gender, hypertension, and primary cancer site were significant risk factors for SPM.

Synchronous and metachronous multiple primary cancers in melanoma survivors: a gender perspective.

Long-term survivors of cutaneous malignant melanoma (CMM) risk subsequent malignancies due to both host-related and environmental risk factors. This retrospective population-based study differentially assesses the risk of synchronous and metachronous cancers in a cohort of CMM survivors stratified by sex. The cohort study (1999-2018) included 9,726 CMM survivors (M = 4,873, F = 4,853) recorded by the cancer registry of all 5,000,000 residents in the Italian Veneto Region. By excluding subsequent CMM and non-CMM skin cancers, the incidence of synchronous and metachronous malignancies was calculated according to sex and tumor site, standardizing for age and calendar year. The Standardized Incidence Ratio (SIR) was calculated as the ratio between the number of subsequent cancers among CMM survivors and the expected number of malignancies among the regional population. Irrespective of the site, the SIR for synchronous cancers increased in both sexes (SIR = 1.90 in males and 1.73 in females). Both sexes also demonstrated an excess risk for synchronous kidney/urinary tract malignancies (SIR = 6.99 in males and 12.11 in females), and women had an increased risk of synchronous breast cancer (SIR = 1.69). CMM male survivors featured a higher risk of metachronous thyroid (SIR = 3.51, 95% CI [1.87, 6.01]), and prostate (SIR = 1.35, 95% CI [1.12, 1.61]) malignancies. Among females, metachronous cancers featured higher SIR values than expected: kidney/urinary tract (SIR = 2.27, 95% CI [1.29, 3.68]), non-Hodgkin's lymphoma (SIR = 2.06, 95% CI [1.24, 3.21]), and breast (SIR = 1.46, 95% CI [1.22, 1.74]). Females had an overall increased risk of metachronous cancers in the first 5 years after CMM diagnosis (SIR = 1.54 at 6-11 months and 1.37 at 1-5 years). Among CMM survivors, the risk of metachronous non-skin cancers is higher than in the general population and differs significantly by sex. These results encourage sex-tailored interventions for metachronous secondary cancer prevention.

Synchronous and Metachronous Breast and Ovarian Cancers: Experience from a Single Tertiary Care Cancer Centre in India.

Women with either breast cancer (BC) or ovarian cancer (OC) have a 1.5-2 times higher risk of developing the other. Discerning discrete primaries versus metastases from either can be challenging. Clinico-pathological and outcome details of patients diagnosed with both BC and OC from December 1994 to August 2018 were retrospectively evaluated at a single tertiary cancer centre. We report the pattern of presentation and recurrences with case-based illustrations.Out of 139 patients, presentation was BC-first in 66.2%, OC-first in 24.5% and synchronous cancers (SC) in 9.3% of women. The median age at diagnosis in BC-first, OC-first and SC was 42years, 48years and 49 years, respectively. The most common histological subtype was invasive breast carcinoma-no special type (74.8%) in BC and serous cystadenocarcinoma (81.3%) in OC. BC presented at an early stage in 67.6% while OC presented at an advanced stage in 48.2% of patients. Germline mutation results were available in 82% with 61.4% of the cohort exhibiting a mutation- BRCA1 mutationbeing the most common. The median time to development of second cancer was 77.4months and 39.4months in BC-first and OC-first, respectively. At a median follow-up of 9.47years, disease-free survival was 32.6%, 32.4% and 30.8% in BC-first, OC-first and SC, respectively (p < 0.001). In hereditary breast and ovarian cancer, BC-first patients have a better prognosis while synchronous malignancies have worse oncological outcomes. Deaths are mainly due to OC progression. Appropriate surveillance and prophylactic intervention in young patients with breast cancer may improve overall outcomes.