Synchronous Multiple Primary Carcinoma Research Articles

Clinical characteristics and prognosis of multiple primary colorectal carcinoma

Objective To explore the clinical characteristics and prognosis of multiple primary colorectal carcinoma. Methods The clinical data of 42 cases of colorectal cancer admitted to the First Affiliated Hospital of Nanjing Medical University between January 2013 and December 2018 were retrospectively analyzed. The clinicopathological features, diagnosis, treatment and prognosis were summarized. Results There were 42 patients with multiple primary colorectal carcinoma, accounting for 1.20% (42/3 499) of all colorectal carcinoma patients in the same period. The main pathological type was adenocarcinoma. Among them, 32 cases were synchronous multiple primary carcinoma. And the age ranged 38-86 years old, and the median age was 66 years old. A total of 73 colorectal cancer lesions were detected, mostly located in the proximal colon, sigmoid colon and rectum. A total of 527 lymph nodes were detected, and the positive rate was 1.9% (10). Patients with positive lymph nodes accounted for 37.5% (12/32), including 27 cases of multiple primary carcinoma, 3 cases of triple primary carcinoma, 2 cases of five primary carcinoma. The 1-year and 3-year overall survival rates were 83.75% and 74.38%, respectively. There were 10 cases of metachronous multiple primary carcinoma. Patients were aged 33-86 years old. The first cancer was mostly located in the rectum and sigmoid colon, and the second cancer was mostly located in the ascending colon area. A total of 276 lymph nodes were detected, and the positive rate was 12.3% (34). The 1-year and 3-year overall survival rates were 100.00% and 66.67%, respectively. Conclusions Multiple primary colorectal cancer is not rare clinically and its distribution shows a certain regularity. More attention should be paid to improve the early diagnosis rate. Early operation is needed to improve the survival rate of patients. Key words: Colorectal neoplasms; Neoplasms, multiple primary; Clinical characteristics; Prognosis

Clinical characteristics, treatments, and prognosis of patients with multiple primary carcinoma of head and neck.

Clinical characteristics, treatments, and prognosis of patients with multiple primary carcinoma of head and neck.

Analysis on the technical characteristics and clinical efficacy of robotic-assisted intersphincteric resection for patients with low rectal cancer

Objective: To explore the technical characteristics and short-term clinical efficacy of robotic-assisted intersphincteric resection (ISR) for patients with low rectal cancer. Methods: A retrospective cohort study was used. Inclusion criteria: (1) rigid colonoscopy showed lower margin of the tumor ≤5 cm from the anal verge; (2) preoperative rectal MRI or endorectal ultrasound revealed staging T1-2, or T3 patients receiving concurrent chemoradiotherapy; (3) patients less than 70 years old with good function of anal sphincter before surgery; (4) no synchronous multiple primary carcinoma, and no distant metastasis; (5) the method of operation was agreed by the patient. Exclusion criteria: (1) T4 stage tumors; (2) sphincter dysfunction before operation; (3) recurrent tumors; (4) lower edge of tumors beyond the dentate line; (5) death due to non-rectal cancer during follow-up and unsatisfactory follow-up data. The clinical data of 21 patients with low rectal cancer meeting inclusion criteria undergoing robotic-assisted ISR at our department from January 2015 to June 2018 were collected. Parameters during and after operation were observed. Anorectal manometry was performed at 3, 6, and 12 months after the operation, and anal function was evaluated at 3, 6, and 12 months after the closure of the stoma by Kirwan classification and Wexner fecal incontinence score. The key steps of the operation are as follows: according to the principle of total mesorectal excision, the robot continued to enter into the levator ani hiatusdistally, and dissectin the sphincter space; according to the scope of sphincter resection, ISRwas divided into partial ISR, subtotal ISR, and total ISR; subtotal and total ISR usually needed to be combined with transanal pathway. The reconstruction of digestive tract was performed by double stapler anastomosis under laparoscope orhand-sewnanastomosis under direct vision, and preventive ileostomy was completed in the right lower abdomen. Results: Of 21 patients, 13 were male and 8 were female with mean age of (57.5±16.3) years. All the patients successfully completed the operation without conversion to laparotomy. Fourteen cases (66.7%) adopted partial ISR through complete transabdominal approach, 6 cases (28.6%) adopted the subtotal ISR through combined transabdominal and transanal approachs, and 1 case (4.8%) adopted the total ISR through the combined transabdominal and transanal approachs. The total operation time was (213.1±56.3) minutes, including (27.3±5.4) minutes for mechanical arm installation and (175.7±51.6) minutes for robotic operation. The amount of intraoperative hemorrhage was (62.8±23.2) ml, and no blood transfusion was performed in any patient. All patients underwent prophylactic ileostomy, and the stoma was closed 3-6 months after the operation. Except one case of anastomotic leakage, all other stomas were closed successfully. The postoperative hospitalization time was (7.6±2.2) days, and time to fluid intake was (3.3±0.9) days. One case of anastomotic leakage, one case of anastomotic stenosis, one case of inflammatory external hemorrhoids and one case of urinary retention occurred after surgery,and all of them were cured by conservative treatment. The mean diameter of tumors was (2.9±1.2) cm, and the number of harvested lymph node was 12.8 ± 3.3. In the whole group, the circumcision margin was negative, the proximal margin was (12.2 ± 2.1) cm, the distal margin was (1.1 ± 0.4) with all negative, and the R0 resection rate was 100%. The results of anorectal manometry showed that the preoperative rest pressure, rectal maximum squeeze pressure, initial sensory volume and maximum tolerated volume were (45.19±8.46) mmHg, (128.18±18.80) mmHg, (44.33±10.11) ml and (119.00±19.28) ml, respectively;these parameters reduced significantly 3 months after operation and they were (23.44±5.54) mmHg, (93.72±12.15) mmHg, (17.72±5.32) ml and (70.44±10.9) ml, respectively. The differences were statistically significant (all P<0.001). The resting pressure and the rectal maximum squeeze pressure returned to preoperative levels 12 months after operation, which were (39.33±6.64) mmHg and (120.58±16.47) mmHg, respectively (both P>0.05), while the initial sensory volume and the maximum tolerated volume failed to reach the preoperative state, which were (30.67±7.45) ml and (92.25±10.32) ml, respectively (both P<0.05). The patients were followed up for (22.1±10.6) months without local recurrence and distant metastasis. Eighteen patients were evaluated for anal function: Kirwan classification was grade I for 6 cases, grade II for 7 cases, grade III for 4 cases, and grade IV for 1 case; Wexner incontinence score was 8.6±0.8; 14 cases had good defecation control. Conclusion: The clinical efficacy of ISR with Da Vinci robot in the treatment of low rectal cancer is satisfactory.

Clinical analysis of 121 cases of urothelial carcinoma accompanied with multiple primary carcinoma

Objective: To investigate the incidence and clinical characteristics of urothelial carcinoma (UC) accompanied with multiple primary carcinoma (MPC). Methods: The clinical data of 121 UC patients with MPC in Peking University Third Hospital from January 2010 to May 2018 were retrospectly analyzed. Results: UC patients with MPC accounted for 9.74% (121/1 242) of all the UC patients. The ratio of male to female patients was 2.10∶1 in the total MPC patients, but it was 1∶1 in the upper urinary tract MPC subgroup. The MPC patients were more common in elderly people, whose medium age was 68 (32-93) years old. Of all the location (131 person-time) of other tumors besides UC, the digestive system tumors occurred most frequently, accounting for 41.98% (55/131), followed by the urinary and male reproductive system tumors (20.61%, 27/131) and the female reproductive system (12.21%, 16/131). The proportion of the digestive system tumors (47.37%, 9/19) was the highest in the upper urinary tract MPC, with a total number of the other primary cancer of 19 person-time. However, the proportion of the urinary and male reproductive system tumors (37.14%, 13/35) was higher in the synchronous MPC group, with a total number of the other primary cancer of 35 person-time. Some patients had a history of radiotherapy and/or chemotherapy before UC was diagnosed. We also observed 2 cases of genetically confirmed Lynch syndrome. The median overall survival (mOS) of UC patients with MPC was 132 months, and the mOS of patients with UC as the first malignancy (including synchronous MPC and UC as the first malignancy in metachronous MPC) was 120 months. The mOS of the synchronous MPC group was 84 months, which was significantly shorter than 178 months of metachronous MPC group (χ(2) =14.029, P<0.001). Conclusions: The incidence of UC accompanied with MPC is not low, and the most common sites of MPC are the digestive system and reproductive system. Therefore, screening for MPC in UC patients, especially those with personal or family history of tumors, as well as elderly patients, may help early diagnosis and treatment of MPC patients and improve their prognoses.

Metachronous and Synchronous Multiple Primary Carcinomas in an Elderly

The prognosis of most cancers has been improved in recent years due to the increased survival of cancer patients, the prolonged lifespan of the general population, and better diagnostic and surgical approaches. Subsequently, the number of patients with multiple primary carcinomas (MPCs) has become greater. In this report, we describe a unique case of a 71-year-old man with five metachronous and synchronous primary malignant tumors. The patient was first diagnosed with synchronous, left posterior tonsillar pillar squamous cell carcinoma (SCC) and right lingual surface of epiglottis SCC in June 2016. Two years later, he presented with three other primary carcinomas within a 3-month time span: right lower lobe lung SCC, right tongue invasive SCC and hepatocellular carcinoma (HCC), consecutively. Investigations revealed no metastases of the primary neoplasms. As the population of older adults with cancer and multimorbidity grows, the therapeutic options usually become limited. On the other hand, understanding the effect of multimorbidity on the care of patients with cancer and developing therapeutic interventions for these elderly patients would be crucial for geriatric care. J Med Cases. 2019;10(1):8-13 doi: https://doi.org/10.14740/jmc3172

Metachronous and Synchronous Multiple Primary Carcinomas in an Elderly

The prognosis of most cancers has been improved in recent years due to the increased survival of cancer patients, the prolonged lifespan of the general population, and better diagnostic and surgical approaches. Subsequently, the number of patients with multiple primary carcinomas (MPCs) has become greater. In this report, we describe a unique case of a 71-year-old man with five metachronous and synchronous primary malignant tumors. The patient was first diagnosed with synchronous, left posterior tonsillar pillar squamous cell carcinoma (SCC) and right lingual surface of epiglottis SCC in June 2016. Two years later, he presented with three other primary carcinomas within a 3-month time span: right lower lobe lung SCC, right tongue invasive SCC and hepatocellular carcinoma (HCC), consecutively. Investigations revealed no metastases of the primary neoplasms. As the population of older adults with cancer and multimorbidity grows, the therapeutic options usually become limited. On the other hand, understanding the effect of multimorbidity on the care of patients with cancer and developing therapeutic interventions for these elderly patients would be crucial for geriatric care. J Med Cases. 2019;10(1):8-13 doi: https://doi.org/10.14740/jmc3172

Application of 18F-FDG PET/CT in patients with synchronous multiple primary carcinoma

Objective: To investigate the value of 18F-fluorodeoxyglucose (18F-FDG) PET/CT in detection of synchronous multiple primary carcinoma (MPC) before treatment. Methods: The pre-treatment whole body PET/CT images of seventy-two patients with synchronous MPC confirmed by postoperative and biopsy pathology were analyzed. The pathological results were used as gold standard, and the detection rates of tumor lesions by 18F-FDG PET/CT and plain CT were compared, and the metabolism of 18F-FDG in tumor lesion was analyzed. Results: There were 151 lesions confirmed by pathology in 72 patients with synchronous MPC. The detection rate of tumor lesions by 18F-FDG-PET/CT was 88.1% (133/151), which was significantly higher than that of integrated CT (78.8%, 119/151) (P < 0.05). In patients with first primary cancer in digestive tract and second primary cancer in lung, the maximal standardized uptake value (SUVmax) of first primary cancer in digestive tract was higher than that of second primary cancer in lung (P = 0.042). There was no significant difference in SUVmax between synchronous MPCs in digestive tract (P = 0.345), but there was significant difference in SUVmax between synchronous MPCs in lung (P = 0.046). There were differences in SUVmax among tumor tissue lesions (P < 0.001), and the SUVmax of digestive tract cancer was higher than that of lung cancer (P = 0.01). Conclusion: The whole body 18F-FDG PET/CT imaging can effectively detect and diagnose the synchronous MPC. DOI:10.3781/j.issn.1000-7431.2018.44.731

Multiple primary carcinomas including esophageal basaloid squamous cell carcinoma and gastric adenocarcinoma

Synchronous multiple primary carcinomas refers to 2 or more than 2 kinds of different primary malignant tumors develop synchronously or in 6 months.The incidence of synchronous multiple primary carcinoma is low.A patient with esophageal basaloid squamous cell carcinoma (BSCC) and gastric adenocarcinoma was admitted to the First People's Hospital of Lianyungang in October 2011.The main symptom of this patient was dysphagia,and multiple lesions were found in esophagus,cardia and stomach fundus by gastroscopy respectively.On computed tomography image,eminence lesion in esophageal midpiece and wall thickening from esophagus-cardia to stomach fundus were displayed and were both enhanced slightly by enhancement scanning.The esophageal and cardia tumors were resected via left thoracic approach,and postoperative pathological examination revealed esophageal BSCC and moderately differentiated adenocarcinoma of cardia respectively.Comedo necrosis and red basal membrane material were seen under light microscope.The expressions of cytokeratin 5/6 and P63 were positive,the expression of cytokeratin L was weak positive and the expressions of synaptophysin,chromogranin A and CD117 were negative.The patient suffered from pleural effusion and multiple liver metastases after 4 months follow-up and died of liver metastases in May 2012.Multiple primary carcinomas including esophageal BSCC and gastric adenocarcinoma are rarely seen in clinical practice.Their diagnosis and differential diagnosis mainly depend on histological morphology and immunohistochemical method.Surgical resection combined with postoperative radiotherapy and chemotherapy is selectable,but the prognosis is poor. Key words: Esophageal neoplasms; Gastric neoplasms; Multiple primary carcinomas

X-ray diagnosis of synchronous multiple primary carcinoma in the upper gastrointestinal tract

To analyze the radiological features of multiple primary carcinoma (MPC) in the upper gastrointestinal (GI) tract, study its biological characteristics and evaluate X-ray examination in its diagnosis. Hypotonic double-contrast GI radiography was performed in 59 multiple primary carcinoma cases, pathologically proved by surgery or endoscopy biopsy. Radiological findings were analyzed. Of the 59 cases, esophageal MPC (EMPC) was seen in 24, esophageal and gastric MPC (EGMPC) in 27 and gastric MPC (GMPC) in 8. Of the 49 lesions found in 24 EMPC, hyperplastic type was seen in 23, medullary type in 9. The lesions were located at the upper (n = 17), middle (n = 19) or lower (n = 13) segment of the esophagus. In 27 EGMPC, the esophageal lesions were located at the middle (n = 16) or lower (n = 11) segment of the esophagus, while the gastric lesions were located at the gastric cardia (n = 16), fundus (n = 1), body (n = 3) and antrum (n = 7). The esophageal lesions were mainly of the hyperplastic type (n = 12) or medullary type (n = 7), while the gastric lesions were mainly of the hyperplastic type (n = 18). A total of 119 lesions in the 59 patients with synchronous multiple carcinoma were proved by surgery or endoscopy biopsy, and preoperative upper radiographic examination detected 100 of them (84.03% sensitivity). Eighteen (52.94%) of the T(1) lesions were found during preoperative diagnosis by radiographic examination. Moreover, only 3 (3.53%) of the T(2-4) lesions were misdiagnosed. Hypotonic double-contrast upper gastrointestinal examination, providing accurate information about lesion morphology, location and size, can serve as a sensitive technique for the preoperative diagnosis of MPC.

Synchronous multiple primary carcinomas of ovary and cervix: a case report

A patient with synchronous multiple primary carcinoma of cervix and ovary is described. A 50 year old patient presenting with abdominal pain and distension over the last four months and two months history of offensive vaginal discharge, weight loss and no contact bleeding. The patient had total abdominal hysterectomy and bilateral salpingoophorectomy. Microscopic examination of the uterus and ovary revealed moderately differentiated squamous cell carcinoma and serous cystadenocarcinoma respectively. This suggests multiple primary malignancies. The follow-up of the patient was unremarkable. There is need to differentiate between primary and metastatic tumour, especially when they involve multiple organs. Keywords: carcinoma, ovary, cervix, metastasis Tropical Journal of Obstetrics and Gynaecology Vol. 23(1) 2006: 75-76

A Case of Synchronous Multiple Primary Carcinomas of the Oral Cavity

A Case of Synchronous Multiple Primary Carcinomas of the Oral Cavity

SYNCHRONOUS MULTIPLE PRIMARY CANCERS -A REPORT OF TWO CASES-

It has been said that carcinomas of the large intestine, breast and corpus uteri share a common pathogenic factor, since these carcinomas often occur simultaneously. When multiple primary carcinomas are simultaneously present, other carcionmas may be ignored resulting in difficult problems with treatment. In the present paper, two cases of synchronous multiple primary carcinomas are reported. One of the patients, an 81-year-old woman, had multiple carcinomas, medullary ductal carcinoma in the breast and moderately differentiated adenocarcinoma in the large intestine, and she underwent simple mastectomy and then excision of the anterior rectum (Hartmann method, R2) three weeks later. The other patient, a 46-year-old woman, had moderately differentiated adenocarcinoma in the large intestine and well differentiated adenocarcinoma in the corpus uteri and she underwent right hemicolectomy (R2) and simple total hysterectomy simultaneously. Although both cases first presented symp-toms of colonic carcinoma, careful examination at the time of admission detected a tumor in the breast and abnormal hemorrhage from the genital region, suggesting the presence of other carcinoma. The postoperative courses of these patients were uneventful, and both have been without any sign of relapse to date over the past nine months. Seven cases, including our case, in which multiple primary carcinoma such as colonic carcinoma and breast cancer or carcinoma of the corpus uteri had been detected, were reviewed and discussed.

Synchronous multiple primary carcinomas of stomach and transverse colon; A case report

Synchronous multiple primary carcinomas of stomach and transverse colon; A case report