Triple Cancer Research Articles

検診にて発見された多中心性両側３重乳癌の１例

検診にて発見された多中心性両側３重乳癌の１例

ｖｏｎ Ｒｅｃｋｌｉｎｇｈａｕｓｅｎ病に合併した３重複癌の１例

ｖｏｎ Ｒｅｃｋｌｉｎｇｈａｕｓｅｎ病に合併した３重複癌の１例

Comparative genomic hybridization 法を用い遺伝的解析を施行した同時性3多発進行大腸癌の1例

We report a rare case of advanced synchronous triple cancer of the colon. A 69-year-old man was admitted to our hospital for bloody stool. Barium enema and colon fiberscopy revealed 3 protruding lesions, 1 in the cecum, 1 in the transverse colon, and 1 in the sigmoid colon. The sigmoid lesion was resected by D3 lymphadenectomy and the cecum and transverse lesions extirpated by D2 lymphadenectomy. Histologically, all 3 tumors were moderately differentiated adenocarcinoma. The sigmoid and transverse lesions had invaded to the subserous level and the cecal lesion to the muscularis propria. No regional lymph node metastasis was seen in any of the tumors. We applied comparative genomic hybridization (CGH) to investigate carcinogeneses cytogenetically and found loss of chromosome arm 17p in all 3 lesions. p53 is located in 17p13, and this suppressor gene plays an important role in the transition from adenoma to carcinoma. Our finding is consistent with the hypothesis that multiple carcinoma of the colon develops in conjunction with the adenoma-carcinoma sequence.

顎口腔領域悪性腫ようにおける多重癌の臨床的検討

Multiple primary cancers of the oral and maxillofacial area were found in 19 (6.6%) of 288 patients presenting to the Department of Oral Surgery of Kawasaki Medical School between April 1974 and March 1996. The study group consisted of 14 males and 5 females. Two patients had triple cancers, and one had multiple cancers of the oral cavity. The average interval between diagnosis of the first primary cancer and that of the second primary tumor was 5 years 9 months, and the median interval was 4 years 1 month. Three patients were in stage I, 8 in stage II, 2 in stage M, and 6 in stage N. We performed radical or multidisciplinary treatment in 16 patients, and 12 died. Eight of the 12 patients had metastasis to other organs, particularly the gastrointestinal tract and liver. Therefore, consultation with other medical specialists is essential.

Quintuple carcinomas with metachronous triple cancer of the esophagus, kidney, and colonic conduit following synchronous double cancer of the stomach and duodenum.

A patient who had undergone radical gastrectomy for synchronous gastric cancer (T(1)N(0)M(0), stage I) and duodenal cancer (Tis, stage 0) in November 1987 was found to have esophageal cancer in November 1994, and underwent radical thoracolaparotomy at our hospital (T(1)N(0)M(0), stage I). After follow-up for about 3.5 years, renal cancer was detected in April 1998, and radical nephrectomy was performed (T(1)N(0)M(0), stage I). Two years later, in April 2000, the patient was found to have a polypoid lesion in the colonic conduit used for reconstruction after esophagectomy, and endoscopic mucosal resection was performed (Tis, stage 0). The patient remains under careful follow-up, including observation of the colonic conduit and the residual large intestine.

THE EXPRESSION OF THYMIDYLATE SYNTHASE IN THE TRIPLE CANCERS INCLUDING STOMACH CANCER

With respect to the immunohistochemical expression of TS, 18 cases of triple cancers were studied and all included gastric cancer. Of the gastric cancers, 3 were synchronous and the others were metachronous against 1 or 2 other cancers. The histological stages of gastric cancer ranged from stage I to IV, and included 9, 5, 2 and 2 cases in the ascending order of stage, respectively. Overall expression of TS was 38.9% in gastric cancers. Chronologically, the rates were 12.5%, 37.5% and 50.0% in preceded, simultaneous and followed gastric cancers, respectively. TS was detectable in 76.0% of other cancers examined, of which colorectal cancer composed one third. Among 10 cases in which TS was examined in each triple cancer site, 2 had 3 cancers with TS(+), 5 had 2 cancers with TS(+) and 3 had 1 cancer with TS(+) and none had TS(-) in all. Prognosis was poorer for the group with positive TS in more than 2 cancer sites than in less TS positivity. Therefore, it was considered that the prognosis of the triple cancer patients could be more predicted by combining TS positivity of each cancer.

Aggressive Surgical Treatment of Multiple Primary Lung Cancers

A case of triple primary lung cancers - squamous cell carcinoma, adenocarcinoma and large-cell carcinoma - is presented. Surgical treatment comprised, respectively, left pneumonectomy, partial resection of the right upper lobe and completion right upper lobectomy. The postoperative courses were uneventful and the patient remains well, with no sign of recurrence, 20 months after the third operation.

AN EXTREMELY AGED PATIENT WITH TRIPLE CANCER RESECTED ON AN ONE-STEP APPROACH-A CASE REPORT-

A case of triple cancer resected on an one-step approach in an extremely aged patient is reported. An 89-year-old woman who was scheduled for elective surgery for right breast cancer was admitted to the hospital on an emergency basis because of intestinal obstruction. She was found to have another cancers in the transverse colon and stomach. A partial resection of the transverse colon, a pyloruspreserving gastrectomy, and a removal of the right breast tumor were simultaneously performed. The cancer of the transverse colon was a 5.0×3.0cm well differentiated adenocarcinoma in stage II. The gastric cancer was a 2.5×2.5cm well differentiated tubular adenocarcinoma in stage IB; and the breast cancer was a 3.0×2.5×2.5cm solid ductal carcinoma in stage II. The patient has been well as of 2 years and 4 months after the operation.

Cronkhite-Canada syndrome associated with triple gastric cancers: a case report

Cronkhite-Canada syndrome associated with triple gastric cancers: a case report

Double cancer observed from bladder cancer

In recent years, despite of the improvement of treatment results for cancer and long life, the occurrence of second primary cancer was increased. In this paper, we analyzed present condition of double cancer observed with bladder cancer in our hospital. Last 21 years, we have treated 969 cases (828 male and 141 female) of primary bladder cancer. For those cases, we analyzed in term of frequency, involved organ, age, interval between two cancer occurrence, risk factor and prognosis of double cancer patients. Of 969 cases with bladder cancer, 81 cases (8.36%) had double cancer involving 6 cases (0.61%) of triple cancer. In sex, 70 males (9.78%) and 11 females (7.80%) had double cancer. As involved organs, 25 cases (3.02%) had in prostate, 23 cases (2.37%) in stomach, 3 case (2.13%) in breast, 14 cases (1.44%) in colon and rectum. In diagnosis timing of complicated cancer from bladder cancer, 28 cases (34.6%) were diagnosed previously to bladder, 28 cases (34.6%) were simultaneously and 31 cases (38.3%) were secondary. An average interval of diagnosis of two cancer were 49 +/- 42.5 months. An average age of occurrence of second cancer was 70.3 +/- 8.8 years. Actual survival rate from diagnosis of bladder cancer were 90.8%, 68.6%, 53.3% and 30.3%, after 1, 3, 5 and 10 years, respectively. Ten cases were dead by bladder cancer, 21 cases by complicated cancer and 16 cases by another cause. The incidence of double cancer with bladder cancer were increased. Prostate cancer, colorectal cancer and breast cancer were gradually increased as complicated organs in Japan. The prognosis of double cancer patients with bladder cancer was poor than single bladder cancer patients.

A Case of Endoscopic Treatment for Synchronous Early Triple Cancers Occurring in the Esophagus, Stomach and Colon

A Case of Endoscopic Treatment for Synchronous Early Triple Cancers Occurring in the Esophagus, Stomach and Colon

A CASE REPORT OF METACHRONOUS TRIPLE CANCER COMPRIZING HEPATOCELLULAR CARCINOMA, GASTRIC CANCER AND TESTICULAR TUMOR

A rare case of metachronous triple cancer comprizing a hepatocellular carcinoma, a gastric cancer and a testicular tumor in a 69-year-old man is reported. The patient was admitted to the hospital because of a liver tumor in December 1995. There was a previous history of undergoing a resection of the testicles to treat a seminoma about 29 years before admission. On this admission, he was diagnosed as having multiple hepatocellular carcinomas (S 5, S 8) by ultrasonography (US), CT scan and angiography. At the same time, an endoscopic examination revealed an early gastric cancer. Thereby a partial hepatectomy and an endoscopical mucosal resection were carried out. Histopathological examination revealed moderately differentiated hepatocellular carcinoma, trabecular type, eg, fc (+), fc-inf (-), vp 0, vv 0, z 2 for the hepatocellular carcinoma and well differentiated adenocarcinoma, mly 0. v 0 for the gastric cancer. The patient died from recurrence of the hepatocellular carcinoma 1 year and 9 months after the operation.

A RESECTED CASE OF INTRAHEPATIC CHOLANGIOCARCINOMA DETECTED 9 YEARS AFTER OPERATION FOR DOUBLE CANCER OF THE STOMACH AND PANCREAS

We have experienced a resected case of intrahepatic cholangiocellular carcinoma of peripharal type oc-curred 9 years after an operation for synchronous double cancer of the stomach and pancreas. A 74-year-old man revealed an increase in level of a tumor marker (CA 19-9:267IU/ml) during medical ovservation following the operation for the double cancer on an ambulant basis. Abdominal CT scanning visu-alized a tumor 3cm in diameter presenting an irregular low density area in the anterior and superior segment of the right lobe (S 8) of the liver. From findings of CT, ultrasonography, and angiography, we found a great deal of difficulty in differentiating whether the hepatic tumor was metastatis of the former gastric or pancreatic cancer or intrahepatic cholangiocellular carcinoma. But we first considered it as intrahepatic cholangiocel-lular carcinoma because it was solitary and 9 years had elapsed after the inital operation, and performed a segmentectomy (S 8) of the liver. The resected material also demonstrated intrahepatic cholangiocellular carcinoma of peripheral type, histopathologically. It is very rare that metachronous triple cancer appears in such combination as early gastric cancer, pan-creatic cancer and intrahepatic cholangio-cellular carcinoma, and hence this case is presented here.

A case of triple cancers with gastric, jejunal and colonic cancers

A case of triple cancers with gastric, jejunal and colonic cancers

A CASE OF HEREDITARY NON-POLYPOSIS COLORECTAL CANCER PRESENTED HETEROCHRONOUS TRIPLE CANCER WITH MULTIPLE COLON CANCER

A case of heterochronous triple cancer with multiple colon cancer in an 80-year-old woman is described. She underwent a right hemicolectomy and a right hepatic lobectomy for cancer of the ascending colon and liver metastasis in 1985 when she was 68 years old. Subsequently, she was operated on for right breast cancer, descending colon cancer, transverse colon cancer and gastric cancer in 1987, 1989, 1994 and 1997, respectively. Moreover her mother, brother and sister had rectal cancer. Additionally her son had brain tumor and gastric cancer. Therefore we diagnose this family as hereditary non-polyposis colorectal cancer (HNPCC) group.

A CASE OF SYNCHRONOUS TRIPLE CANCER INVOLVING THE ESOPHAGUS, STOMACH AND URETER

We herein report a case of synchronous triple cancer involving the esophagus, stomach (double cancer), and ureter. A 62-year-old man was diagnosed as having double cancer of hte esophagus and stomach by endoscopy performed for a follow-up study of gastric ulcer. Preoperative screening abdominal ultrasonography showed a right hydronephrosis, and a cytological examination of the urine revealed malignant transitional cells. A preoperative diagnosis of synchronus triple cancer (esophagus, stomach and ureter) was thus made. After an endoscopic mucosal resection for the early esophageal cancer, a radical total gastrectomy and a right nephroureterectomy were successfully carried out. Postoperative pathological examination revealed that the esophageal cancer was squamous cell carcinoma, the gastric cancer was well-differentiated adenocarcinoma, and the ureteral cancer was transitional cell carcinoma. Whenever we encounter cancers of the gastrointestinal tract including hepato-biliary-pancreatic system the possible coexistance of multiple malignancies occurring in other organs must be kept in mind.

A CASE OF MULTIPLE CANCER OF THE GALL BLADDER AND KIDNEY WHICH OCCURRED SEVEN YEARS AFTER THE OPERATION FOR STOMACH CANCER

We experienced a rare case of multiple cancer of the stomach, gallbladder, and kidney. An 84-year-old woman with a past history of undergoing a distal gastrectomy for a gastric cancer at the age of 77, was admitted to the hospital because of general fatigue in June, 1994. Abdominal ultrasonography and CT revealed a polypoid lesion in the gallbladder and a tumor in the left kidney. Resection of the gallbladder and left kidney was performed. Histophathologically, the tumor of the gallbladder was well differentiated adenocarcinoma and that of the kidney was clear cell type of renal carcinoma. Definitive diagnosis of synchronous double cancer of the gallbladder and left kidney or heterochronous triple cancer of the stomach, gallbladder and left kidney was made. It is thought that the curative surgery of the first cancer and the advances in imaging techniques may contribute to the occurrence and diagnosis of this synchronous double cancer.

三重癌（胃・腎・直腸）に多数の良性腫瘍を伴った1例

症例は78歳男性で，胃と左腎の同時重複癌および直腸に生じた異時重複癌の三重癌を認めた。胃癌についてはポリペクトミーを施行したが，切除断端陽性のためヒートプローブにて焼灼治療を行った。また腎・直腸癌に対しては，根治的手術を施行した。本症例は腎腺腫，腎血管筋脂肪腫，副腎皮質腺腫，耳下腺多形腺腫，甲状腺腺腫と多数の良性腫瘍を合併しており，また胃・左腎・直腸の組み合わせという点でまれな症例と考えられた。多発癌における経配偶子性遺伝子変異の関与も考慮し，リンパ球および腫瘍組織のp53遺伝子の変異を検索したが異常を認めず，家族歴と併せると遺伝的因子の関与は否定的であった。近年，重複癌は増加傾向にあり，原因として癌好発年齢層の広がり，癌発見率の向上，環境の変化，治療による誘発などが指摘されている。われわれは癌患者の診療に際し，常に多重癌の可能性を考慮する必要があると思われた。

442 Analysis of the patients who had double or triple primary cancers included primary lung cancer

442 Analysis of the patients who had double or triple primary cancers included primary lung cancer

Quintuple cancers: report of a case with triple cancers in the head and neck

The incidence of multiple primary cancers is increasing. We report a case of quintuple cancers, two located in the genitourinary tract and three arising on the upper aerodigestive tract, two synchronous squamous cell carcinomas of the oral mucosa and another on the larynx. We also present a brief review of the literature.