Synchronous Tumors Research Articles

Double trouble: Synchronous T-cell lymphoma and colonic adenocarcinoma

ABSTRACT Background: Synchronous tumors consisting of colorectal adenocarcinoma and lymphoma are infrequent and pose a tricky situation to the clinicians for the management. Observations: We present a case of a 67-year-old male ex-alcoholic who presented with loss of appetite, weight loss for 3 weeks, high fever, abdominal pain for 2 days, and difficulty in passing stool for 1 month. Upon examination and further investigations, a diagnosis of stage 4 peripheral T-cell lymphoma, moderately differentiated sigmoid colon adenocarcinoma with liver metastasis, and SIADH-tumor associated was made. In light of the case’s metastatic disease, the tumor board opted to proceed with stenting for the sigmoid colon mass and chemotherapy for the peripheral T-cell lymphoma. Conclusion: It is certain that with the development of regular screening programs and extensive evaluation across the country, early identification and diagnosis can lead to efficient treatment plans and can improve the prognosis significantly.

Clinical outcomes of early gastric cancer resected by endoscopic submucosal dissection at young age.

314 Background: A small portion of patients are diagnosed as early gastric cancer (EGC) and undergo endoscopic submucosal dissection (ESD) at young age, however, their clinical outcomes are rarely known. We investigated clinical characteristics and outcomes of patients who underwent ESD for treatment of EGC at age under 50. Methods: We enrolled patients who were diagnosed as EGC and underwent ESD during 2006 and 2020. We divided them either for young age (YA) group if age ≤ 50 years and other age (OA) group if > 50 years. Results: We enrolled 1,349 patients (YA group: 105 patients [7.8%], OA group: 1244 [92.2%]). Compared with OA group, YA group contained more female patients (36.2 vs. 26.5%, P= 0.033), their tumor was located at middle third (41.0 vs. 29.6%, P= 0.006) and was depressed (40.0 vs. 28.8%, P= 0.001), and had more undifferentiated (30.5 vs. 12.1%, P< 0.001) and diffuse type (22.9 vs. 7.3%, P< 0.001) histology. However, synchronous tumor was less frequent in YA group (2.9 vs. 12.4%, P= 0.001). When we sorted 884 patients who achieved curative resection and were followed-up longer than 12 months, Kaplan-Meier analysis showed that metachronous neoplasm (dysplasia or cancer) and metachronous cancer were significantly less in YA group than OA group ( P= 0.003 and 0.013, respectively), however, local recurrence was not significantly different between two groups. Conclusions: ESD is a favorable and effective therapeutic modality for EGC patients who are aged under 50, once curative resection is achieved.

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.

Double Synchronous Primary Tumors: Metastatic Melanoma and Advanced Pulmonary Adenocarcinoma in a 32-Year-Old Adult: Case Report and Literature Review

Introduction: The presence of multiple primary malignant neoplasms is an unusual finding during the diagnostic approach of patients with cancer. The coexistence of melanoma with lung adenocarcinoma is extremely rare according to some cohort studies since a prevalence of 0.05% is estimated in this group of patients. The most relevant risk factors for the development of multiple malignant tumors are genetic, environmental exposures to carcinogenic substances, and treatment of a preexistent cancer. Case description: Male, 32 years old who denies family history of malignant neoplasms, drug addiction, chronic degenerative diseases, allergies, surgeries, and hospitalizations. His main symptom was a progressive weakness of the right upper and lower limb which, over a period of days, made it impossible to walk. During his hospitalization, MRI revealed metastatic lesions associated with vasogenic edema. For this reason, an evaluation was requested by the neurosurgery service, who performed a decompressive craniectomy with a biopsy that reported malignant cells consistent with metastatic melanoma. As part of the diagnostic approach, a thoracoabdominal CT with IV contrast was performed, which revealed another tumor at the lung level in the left lower lobe that obliterates the bronchus, not suggestive of metastatic activity, for this reason a lung biopsy was performed, which reported findings of poorly differentiated adenocarcinoma with angiolymphatic invasion present and extensive necrosis. The patient was discharged home with the palliative care measures due to the poor prognosis of both stage IV cancers reported synchronously. Conclusion: The coexistence of 2 primary different cancers in the same patient is an unusual phenomenon which represents a challenge for the multidisciplinary team that treats the patient. Likewise, the coexistence between melanoma and lung adenocarcinoma is exceptionally reported in the literature, which in advanced phases confers a poor prognosis and few therapeutic options.

Endometrial Serous Adenocarcinoma and Perineal Leiomyosarcoma: A rare case report of Synchronous Primaries

The simultaneous presentation of endometrial carcinoma and perineal leiomyosarcoma in a patient as a synchronous tumor is very rare.

Using machine learning models to predict synchronous genitourinary cancers among gastrointestinal stromal tumor patients.

Gastrointestinal stromal tumors (GISTs) can occur synchronously with other neoplasms, including the genitourinary (GU) system. Machine learning (ML) may be a valuable tool in predicting synchronous GU tumors in GIST patients, and thus improving prognosis. This study aims to evaluate the use of ML algorithms to predict synchronous GU tumors among GIST patients in a specialist research center in Saudi Arabia. We analyzed data from all patients with histopathologically confirmed GIST at our facility from 2003 to 2020. Patient files were reviewed for the presence of renal cell carcinoma, adrenal tumors, or other GU cancers. Three supervised ML algorithms were used: logistic regression, XGBoost Regressor, and random forests (RFs). A set of variables, including independent attributes, was entered into the models. A total of 170 patients were included in the study, with 58.8% (n = 100) being male. The median age was 57 (range: 9-91) years. The majority of GISTs were gastric (60%, n = 102) with a spindle cell histology. The most common stage at diagnosis was T2 (27.6%, n = 47) and N0 (20%, n = 34). Six patients (3.5%) had synchronous GU tumors. The RF model achieved the highest accuracy with 97.1%. Our study suggests that the RF model is an effective tool for predicting synchronous GU tumors in GIST patients. Larger multicenter studies, utilizing more powerful algorithms such as deep learning and other artificial intelligence subsets, are necessary to further refine and improve these predictions.

Primary tumor sidedness is not prognostic factor in resectable colorectal cancer liver metastasis: a retrospective observational cohort study.

Right-sided tumors have been reported to have a poorer survival rate than left-sided tumors; however, there remains debate regarding whether sidedness is an independent prognostic factor in colorectal cancer liver metastasis (CRLM). This study aimed to assess the impact of sidedness on prognosis in resectable CRLM and to identify prognostic factors. Patients who underwent liver resection for CRLM at Samsung Medical Center from January 2008 to December 2021 were included in the investigation. Overall survival (OS) and progression-free survival (PFS) were analyzed, and prognostic factors were identified. A total of 497 patients were included in the study, with 106 on the right side and 391 on the left side. The right-sided group had a higher percentage of synchronous tumors (90.6% vs. 80.3%, P = 0.020). In survival analysis, the right side showed lower 5-year OS (49.7% vs. 54.2, P = 0.305) and 5-year PFS (57.1% vs. 60.2%, P = 0.271), but the differences were not statistically significant. In the analysis of prognostic factors, synchronous tumor (odds ratio [OR], 5.01; P < 0.001), CEA (OR, 1.46; P = 0.016), and maximum tumor size of hepatic metastasis (OR, 1.09; P = 0.026) were associated with OS. In resectable CRLM, there was no difference in prognosis based on sidedness. CEA level, synchronous tumor, and maximum tumor size of hepatic metastasis were identified as prognostic factors.

Synchronous neoplasms in a paediatric patient

Synchronous neoplasms in a paediatric patient

Log odds of positive nodes as a prognostic factor for rectal cancer: a retrospective study.

Rectal cancer is an important cause of mortality and morbidity globally. The aim of this study was to investigate whether the log odds of positive nodes system is a better indicator than tumor node metastasis and lymph node ratio systems to determine rectum cancer prognosis, which is an important cause of mortality and morbidity globally. This was a single-center retrospective cross-sectional study. Data were obtained from the medical records of patients with rectum adenocarcinoma followed at Gazi University Hospital. The clinicopathological data of 128 patients with rectum adenocarcinoma who underwent low anterior resection or abdominoperineal resection between January 2010 and December 2018 was retrospectively reviewed. Patients with rectum adenocarcinoma as the first and only primary diagnosis, which was confirmed by histopathological examination, than those who had undergone complete curative resection via low anterior resection or abdominoperineal resection were included. Those with familial adenomatous polyposis or Lynch syndrome, those under 18 years of age, with a synchronous tumor, peritoneal spread, or metastatic disease at the time of diagnosis, and those with <12 lymph nodes dissected from the resection material were excluded from the study. In multivariate analysis, age, perineural invasion, tumor node metastasis stage, lymph node ratio stage, and log odds of positive nodes stage were found to be independent prognostic factors (p<0.05). LODDS2 patients' mortality rates were 9.495 times higher than LODDS0 patients [hazard ratio=9.495, (95%CI 4.155-21.694), p<0.001] while LNR2 stage patients' mortality rates were 7.016 times higher than LNR0 stage patients [hazard ratio=7.016, (95%CI 3.123-15.765), p<0.001] and N2 stage patients had a 5.135 times higher risk of mortality than those who were in N0 stage [hazard ratio=5.135 (95%CI 2.451-10.756), p<0.001]. Log odds of positive nodes is a more valuable prognostic factor for rectal cancer patients than tumor node metastasis and lymph node ratio systems to determine rectum cancer prognosis.

Factors affecting survival in stage 2-3 colorectal cancer: a single-center retrospective study.

The principal aim of this research is to investigate the variables that exert a discernible impact on the overall survival (OS) of individuals afflicted with colorectal cancer (CRC) harboring pathologic stages 2-3, as delineated within the TNM staging schema tailored to CRC, an established framework governed by the American Joint Committee on Cancer (AJCC). Patients with preoperative stages 1 and 4, patients with a history of other organ malignancy, patients who could not undergo curative resection, patients with systemic malignant diseases (leukemia, lymphoma, etc.), patients with synchronous tumors, and patients with positive surgical margins were excluded from the study. Notable pathological parameters, including tumor grade, perforation status, lymphovascular invasion, perineural invasion, the presence of mucinous components, and tumor size, were ascertained through pathological examination of resected specimens. Curative resection was performed on 241 patients. The mean age of all patients was calculated to be 65.67±16.04. The average tumor size was measured as 5.03±2.22 cm. The 1-year survival rate of the patients was found to be 84.3%, 3-year survival rate was 69.0%, and 5-year survival rate was 52.9%. According to the COX regression analysis, the categorical variables that were found to be significantly associated with OS were grade (p=0.046), emergency surgery (p<0.001), and tumor localization (p=0.015). The initial patient and tumor characteristics at baseline have demonstrated substantial predictive capacity regarding patient outcomes following disease recurrence. Survival analyses showed that undergoing emergency surgery, having the tumor located in the rectum, and having a "poor" tumor grade adversely affected survival.

The Role of Lymphovascular Space Invasion and Cytology in the Prognosis of Endometrial Cancer.

Lymphovascular space invasion (LVSI) and cytology are both independent and strong prognostic factors in endometrial cancer. This study aims to highlight the impact of LVSI and cytology positivity on prognosis, in addition to molecular classification. A retrospective review was conducted on the records of 223 patients with endometrial cancer diagnosed between January 2011 and January 2021. The inclusion criteria stipulated that the patients were diagnosed with endometrial cancer by endometrial biopsy and were operated in the clinic. The exclusion criteria included sarcoma in the postoperative pathology report results or synchronous tumor. Staging was performed according to the Fédération internationale de gynécologie et d'obstétrique (FIGO) 2009 criteria. Cytology (using 50 cc saline) was obtained upon entry into the peritoneal cavity. In 20 patients, saline was not used due to the presence of ascites in the abdomen. The Kaplan-Meier method was employed to evaluate overall survival and progression-free survival. Survival rates were compared in terms of cytology and LVSI. After analyzing the postoperative pathology results, it was found that the mean tumor size was 4.03 ± 2.3 cm. The most common histological type was endometrioid carcinoma, with stage IA being the most common stage. Out of 223 patients with endometrial cancer, the overall survival rate was 82.4%, and the progression-free survival rate was 88.3%. For patients negative for LVSI, the progression-free survival rate was 93%, while for LVSI-positive patients, it was 77.3% (p < 0.001). Additionally, the progression-free survival rate for patients negative for cytology was 90.4%, whereas for cytology-positive patients, it was 77.1% (p < 0.05). In our study, we observed that LVSI positivity and cytology positivity also reduced the overall survival rate. We aimed to highlight that, in addition to molecular classification, cytology positivity and LVSI positivity are still highly significant and independent factors in prognosis.

Pancreatic neuroendocrine tumors mimicking pancreatic metastases in post-nephrectomy patients or in synchronous kidney neoplasm

Pancreatic neuroendocrine tumors mimicking pancreatic metastases in post-nephrectomy patients or in synchronous kidney neoplasm

Lactoferrin docking NIR-II cyanine dye as a potentiated phototheranostic for synchronous multimodal bioimaging and tumor photo-immunotherapy.

Rationale: A promising dye for phototheranostics, IR-1048 is a near-infrared region II (NIR-II) cyanine dye that exhibits exceptional optical characteristics in NIR-II spectrum. Unfortunately, the biological applications of IR-1048 are challenged by its hydrophobic nature, the formation of face-to-face stacked dimeric aggregates (H-aggregates) that result in pronounced spectral blue shifts, and issues related to fluorescence quenching. Method: We present a novel docking strategy involving bovine serum albumin (BSA) and lactoferrin (Lf) to construct BSA@IR-1048 and Lf@IR-1048 nanoprobes. The NIR-II optical characteristics of these nanoprobes have been thoroughly investigated through both theoretical and experimental approaches. In addition, we conducted in vitro and in vivo evaluations of their NIR-II photothermal and photodynamic properties, multimodal imaging capabilities, and effectiveness in photoimmunotherapy. Results: Following the protein docking process, both BSA@IR-1048 and Lf@IR-1048 probes exhibited a red-shifted absorbance peak and an "ON" state in NIR-II fluorescence. Theoretical analyses alongside experimental results indicate that Lf@IR-1048, which has a higher docking binding energy of -10.83 kcal/mol, significantly enhances optical characteristics in the NIR-II region. Notably, when utilizing a single NIR-II light source, Lf@IR-1048 was effective in producing single-linear state oxygen and converting photons into heat energy, achieving a photo-thermal conversion efficiency of 41.9%. The overexpression of transferrin receptors in tumor cells also improved tumor-targeting and enrichment capabilities of Lf@IR-1048, as demonstrated vitro and in vivo studies. Comparatively, Lf@IR-1048 facilitated multimodal imaging-guided NIR-II phototherapy, showing an impressive tumor development inhibition rate of 94.8%. Furthermore, in bilateral CT26 tumor-bearing mice, the Lf@IR-1048-based photo-immunotherapy exhibited significant antitumor activity, attributed to enhanced dendritic cell maturation and infiltration of cytotoxic T lymphocytes. Conclusion: Lf@IR-1048 displays a powerful combination of photothermal therapy, photodynamic therapy, and tumor-targeting potential for effective multimodal imaging-guided NIR-II phototherapy, leading to substantial inhibition of tumor growth.

Multiple primary synchronous tumors: features of modern diagnosis and treatment

Multiple primary synchronous tumors: features of modern diagnosis and treatment

Low-Grade Appendiceal Mucinous Neoplasia and Neuroendocrine Appendiceal Synchronous Tumor: A Rare Case Report and Review of Literature for 13 Cases

Low-Grade Appendiceal Mucinous Neoplasia and Neuroendocrine Appendiceal Synchronous Tumor: A Rare Case Report and Review of Literature for 13 Cases

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.

Step Serial Sectioning in Head and Neck Squamous Cell Carcinoma of Unknown Primary

Patients with suspected head and neck squamous cell carcinoma of unknown primary (HNSCCUP) may undergo tonsillectomy and tongue base mucosectomy (TBM) to help identify clinicoradiologically occult primary disease. It is hypothesized that when these diagnostic specimens are analyzed, conventional histopathological (CH) techniques risk missing small primary tumors that may be hidden in the tissue blocks. To establish the outcomes of a step serial sectioning (SSS) histopathological technique vs CH when analyzing diagnostic tissue specimens from TBM and tonsillectomy performed for HNSCCUP. The MOSES prospective multicenter noninterventional cohort study was conducted over a 25-month period from November 2019 at secondary and tertiary care ear, nose, and throat departments in the United Kingdom and included adults with clinicoradiologically occult HNSCCUP who were undergoing TBM. Conventional histopathological techniques performed on TBM and tonsillectomy specimens at participating centers, followed by SSS performed at the central laboratory. Identification of cancer on central histopathological review of TBM and tonsillectomy specimens. Tissue from 58 eligible patients was analyzed (median [range] age, 58 [47-82] years; 10 women [17%]), with 20 480 sections cut in the laboratory and 4096 sections directly examined by a pathologist (median [range], 64 [28-135] per patient). The overall identification rate for TBM following SSS according to study protocol was 50.0% (95% CI, 37.5%-62.5%) and by subgroups was 42.9% (95% CI, 21.4%-67.4%) when performed following a negative bilateral tonsillectomy, 46.7% (95% CI, 24.8%-69.9%) at the same time as bilateral tonsillectomy, and 57.1% (95% CI, 36.5%-75.5%) following historic tonsillectomy. Conventional histopathological techniques at central review identified 2 undiagnosed primary tumors and revised the diagnosis of 2 other cases (1 nonmalignant and another down staged). Step serial sectioning identified a single additional tumor: an ipsilateral synchronous tongue base tumor for which a contralateral tumor had been identified on CH. Multifocal disease was seen in 5 (8.6%); all were human papillomavirus-related and in the tongue base. In this multicenter cohort study of patients undergoing TBM for HNSCCUP, SSS was associated with added considerable histopathological workload with minimal additional diagnostic benefit. A second opinion for conventional histological techniques may be more beneficial. Synchronous primary disease should be considered when planning diagnostic oropharyngeal surgery for these patients.

Shwannoma of the stomach and synchronous cancer of the transverse colon: a clinical case report

With an increase in the frequency of publication of clinical observations with synchronous neoplasms of different histological types, experience is accumulating in the diagnosis and treatment of this cohort of patients. new clinical guidelines and strategies for the treatment of patients with primary multiple neoplasms of the gastrointestinal tract are being developed. A significant number of identified cases of the development of minimally invasive laparoscopic and robotic surgical interventions for primary multiple neoplasms of the gastrointestinal tract, as well as an increasing number of studies demonstrating the integrity and safety of performing minimally invasive endoscopic intraluminal aids in small mesenchymal tumors. The clinical observation presents the data of patient 82 years old with benign schwannoma and adenocarcinoma of the transverse colon.

Genetic and epigenetic features of bilateral Wilms tumor predisposition in patients from the Children’s Oncology Group AREN18B5-Q

Developing synchronous bilateral Wilms tumor suggests an underlying (epi)genetic predisposition. Here, we evaluate this predisposition in 68 patients using whole exome or genome sequencing (n = 85 tumors from 61 patients with matched germline blood DNA), RNA-seq (n = 99 tumors), and DNA methylation analysis (n = 61 peripheral blood, n = 29 non-diseased kidney, n = 99 tumors). We determine the predominant events for bilateral Wilms tumor predisposition: 1)pre-zygotic germline genetic variants readily detectable in blood DNA [WT1 (14.8%), NYNRIN (6.6%), TRIM28 (5%), and BRCA-related genes (5%)] or 2)post-zygotic epigenetic hypermethylation at 11p15.5 H19/ICR1 that may require analysis of multiple tissue types for diagnosis. Of 99 total tumor specimens, 16 (16.1%) have 11p15.5 normal retention of imprinting, 25 (25.2%) have 11p15.5 copy neutral loss of heterozygosity, and 58 (58.6%) have 11p15.5 H19/ICR1 epigenetic hypermethylation (loss of imprinting). Here, we ascertain the epigenetic and genetic modes of bilateral Wilms tumor predisposition.

The correlation between the main and minor lesions of synchronous multiple gastric neoplasms assessed gastroscopically and microscopically.

Patients with early gastric cancer (EGC) are at high risk of developing synchronous multiple gastric neoplasms (SMGNs) after undergoing endoscopic submucosal dissection (ESD). However, most previous studies have had small sample sizes, and few have focused on association studies. This study aimed to analyze the associations between SMGN lesion data from patients with EGC treated with ESD and their correlation coefficients. The clinical ESD data from two hospitals from January 2008 to January 2021 were retrospectively analyzed. The main lesions were defined as those with a significant depth of infiltration. The larger tumor diameter was considered the main lesion if the lesions had the same infiltration depth. Of the 1013 post-ESD cases examined, 95 cases (223 lesions) had SMGN, and 25 patients had more than three lesions. For the correlation analysis, 190 lesions were included. The study revealed a similarity in pathological type between main and minor lesions (rs = 0.37) and a positive correlation in infiltration depth (rs = 0.58). The mean diameter sizes of the main and minor lesions were 20.7 ± 8.3mm and 13.1 ± 6.4mm, respectively, with statistically significant differences (P < 0.001). A linear correlation was observed between the diameter size and a linear regression model was constructed, producing r = 0.38 [95% confidence interval (CI) 0.19-0.54], b = 0.29 (95% CI 0.14-0.44), t = 3.94, P < 0.001]. A correlation was identified between the vertical distribution of the main and minor lesions, the horizontal distribution, and the gross endoscopic morphology (ϕc = 0.25, P = 0.02; ϕc = 0.32, P < 0.001; ϕc = 0.60, P < 0.001). The correlation coefficients for microscopic characteristics were higher than those for gastroscopy. There is a significant positive correlation between the main and minor lesions regarding pathological stage and depth of infiltration, respectively. The spatial distribution of the lesions and the gastroscopic morphology were similar.