One Pulmonary Lesion, 2 Synchronous Malignancies

Introduction. Mantle cell lymphoma (MCL) comprises approximately 3% to 10% of all non-Hodgkin lymphomas. Although there is an increased risk for secondary malignancies after treatment among non-Hodgkin lymphomas survivors, a synchronous diagnosis of primary lung cancer arising in conjunction with lymphoma at the same site has rarely been reported. We report an unusual case of primary lung adenocarcinoma with coexistent MCL within the same lung lesion. Case Presentation. A 55-year-old female with newly diagnosed stage IV-B MCL was referred for workup of a right upper lobe cavitary lesion detected during lymphoma staging. A whole-body positron-emission tomography-computed tomography scan revealed diffuse adenopathy but also identified a cavitary right upper lobe lesion atypical for lymphoma. Bronchoscopy was unremarkable with cytology (on lavage) negative for malignancy. At 2 months, a computed tomography scan of the chest showed a persistent lesion. A video-assisted thoracoscopic wedge resection was performed. Histopathological examination revealed a lepidic predominant, well-differentiated adenocarcinoma (stage T1a) and foci of lymphoid infiltrate within and adjacent to the adenocarcinoma consistent with lung involvement by MCL. Discussion. Synchronous presentation of primary lung adenocarcinoma and lymphoma at a single site is exceedingly rare. Nonresolving pulmonary lesions with features atypical for lymphoma should be viewed with caution and worked up comprehensively to rule out occult second malignancies, in order to guide a prompt diagnosis and appropriate treatment

Synchronous malignancies in patients with breast cancer

Introduction. The continuously improving cancer detection at an early stage and improving survival rates have been observed and, therefore, patients are predisposed to detection of multiple primaries. It has been reported that the incidence of multiple primaries in breast cancer patients ranges from of 4% to 17%. Materials and methods. A group of 112 breast cancer patients with synchronous malignancies was presented. They constituted 0.09% of patients (118,952 cases) who were treated for breast cancer at the same time period, and made up 3.5% of all patients (3,176 cases) with multiple primary cancers, and 21.7% of all patients (517 cases) with breast cancer who developed multiple primaries. Results. The most frequent type of synchronous primary malignancy was breast cancer (63.4%) and 90.1% of them were diagnosed at the same time or within one month following the first breast cancer diagnosis. Among cases of non-breast synchronous primaries, female genital organ malignancies were predominant (36.6%). Synchronous breast cancer was diagnosed significantly earlier than non-breast cancers (mean time was 0.4 and 1 month, respectively, p = 0.0123). Better results in the group with synchronous contralateral breast cancer in comparison to synchronous breast and non-breast cancer were observed (5-year overall survival rates were 90.9% and 66.3%, respectively, and 5-year disease-free survival rate — 62.5% and 51.3%, respectively)

Synchronous malignancies in patients with breast cancer

Introduction. The continuously improving cancer detection at an early stage and improving survival rates have been observed and, therefore, patients are predisposed to detection of multiple primaries. It has been reported that the incidence of multiple primaries in breast cancer patients ranges from of 4% to 17%. Materials and methods. A group of 112 breast cancer patients with synchronous malignancies was presented. They constituted 0.09% of patients (118,952 cases) who were treated for breast cancer at the same time period, and made up 3.5% of all patients (3,176 cases) with multiple primary cancers, and 21.7% of all patients (517 cases) with breast cancer who developed multiple primaries. Results. The most frequent type of synchronous primary malignancy was breast cancer (63.4%) and 90.1% of them were diagnosed at the same time or within one month following the first breast cancer diagnosis. Among cases of non-breast synchronous primaries, female genital organ malignancies were predominant (36.6%). Synchronous breast cancer was diagnosed significantly earlier than non-breast cancers (mean time was 0.4 and 1 month, respectively, p = 0.0123). Better results in the group with synchronous contralateral breast cancer in comparison to synchronous breast and non-breast cancer were observed (5-year overall survival rates were 90.9% and 66.3%, respectively, and 5-year disease-free survival rate — 62.5% and 51.3%, respectively)

A Characterization of Colorectal Carcinoma In Patients From The Upper Peninsula of Michigan

As the third most commonly diagnosed malignancy and second leading cause of cancer-related death, colorectal cancer remains a major global healthcare concern. Despite numerous studies to elucidate the mutations involved in tumorigenesis and assist with the prognostic stratification of patients, individual outcomes and therapeutic responses remain unpredictable. In this study, we performed a retrospective analysis of the clinical and pathological features of colorectal cancers diagnosed in the Upper Peninsula of Michigan. We then characterized the frequency and diversity of six molecular markers (MMR, BRAF, NRAS, KRAS, PIK3CA, PD-L1) in matched samples belonging to 120 patients in our cohort and correlated the findings with cancer registry data. PCR-based assays were performed to identify point mutations in the RAS, RAF and PIK3CA pathways using zinc formalin-fixed, paraffin-embedded blocks belonging to the patients in our cohort. Additionally, immunohistochemical stains were prepared to assess DNA mismatch repair protein expression and PD-L1 status in the tumor cells. Individual mutations were correlated with the clinical -pathological features of CRC in patients. We noted a higher frequency of primary tumors arising in the proximal colon, as well as a potential prognostic value in KRAS and PIK3CA mutation testing. We believe this is the first population-based study to characterize and correlate mutations with clinicopathological variables in colorectal cancer patients from the Upper Peninsula of Michigan. The findings presented here provide additional insight regarding the tumor microenvironment at various stages of disease and may lead to more effective patient management strategies as well as the development of new companion diagnostics

Esophageal Small Cell Carcinoma with Synchronous Renal Cell Carcinoma: A Case Report with Review of the Literature

Synchronous malignancies with an esophageal malignancy are not uncommon. However synchronous esophageal and renal cell carcinoma (RCC) is rare with only 11 cases reported in the world literature, the esophageal malignancies being adenocarcinomas or squamous cell carcinomas. Here, we report the first case of synchronous small cell carcinoma (SCC) of the esophagus with a RCC. SCC of the esophagus is an aggressive malignancy with poor prognosis constituting 0.8–2.4% of all esophageal malignancies, currently treated with induction chemotherapy followed by chemoradiotherapy. Our patient underwent chemoradiotherapy for the SCC of the esophagus followed by radical nephrectomy for the RCC. He developed metastatic disease and died 8 months after diagnosis. Larger case series are required to develop a treatment algorithm for such a rare presentation. The key points of this report are: (1) Synchronous RCC with a primary esophageal carcinoma is a rare presentation. (2) This is the first described case report of a SCC of the esophagus with a synchronous RCC. (3) Overall prognosis in a synchronous presentation is determined by the primary esophageal malignancy. (4) Esophageal carcinomas with synchronous malignancies have a poorer prognosis compared to isolated esophageal carcinoma

Synchronous Gastric Carcinoma and Nodal Malignant Lymphoma: A Rare Case Report and Literature Review

Synchronous double malignancies of gastric carcinoma (GC) and malignant lymphoma (ML) are rare and very difficult to treat. We report a case of synchronous GC and nodal ML, regarding which clinical and pathological features and treatment are discussed. A 68-year-old woman with a history of inguinal hernia was admitted for abdominal pain and high fever and subsequently underwent herniorrhaphy, but the fever remained. Computerized tomography showed a stomach mass and multiple enlarged lymph nodes in the abdominal cavity and inguinal regions. Gastric adenocarcinoma coexistent with advanced in situ follicular lymphoma was confirmed by endoscopy, biopsy of inguinal lymph nodes and bone marrow examination. Two chemotherapy regimens, R-CHOP (rituximab, cyclophosphamide, perarubicin, vincristine and prednisone) and systemic therapy (5-fluorouracil and calcium folinate) combined with regional perfusion (oxaliplatin and etoposide) through the left gastric artery were performed at intervals against ML and GC, respectively. Partial remission in both tumors was achieved after 4 courses of treatment, but the patient finally died of heart failure. Scrupulous biopsy of non-draining lymph nodes in patients with gastrointestinal carcinomas is supposed to improve the diagnostic rate of simultaneous nodal ML. The interval chemotherapy strategy with two independent regimens is beneficial for such patients, especially for those unable to tolerate major surgery

Adrenomedullin in pancreatic carcinoma. a case-control study of 22 patients

Pancreatic carcinoma is a leading cause of cancer-related death. Reduction of the diagnostic delay is mandatory. Adrenomedullin (AM) is overexpressed in pancreatic cancer. A case-control study including 12 patients with pathological diagnosis of pancreatic carcinoma and 10 healthy controls was conducted at our Institution. Blood samples were obtained at the time of hospitalization and post-operatively for cases. Controls’ samples were obtained from healthy volunteers. AM was measured by using enzyme immunoassay method. AM showed significant increase in pancreatic carcinoma patients vs controls (4.51 ng/ml vs 1.91 ng/ml, p value = 0.04) regardless of tumor stage, differentiation, resecability/unresecability, diabetes. A cut-off of 1.75 ng/ml reaches a sensibility of 83% and a specificity of 70% (p value = 0.0147; CL 95%; AUC 0.767). The increase of AM didn’t correlate with the increase of other common tumor markers (CA 19-9 and CEA), nor direct bilirubin. These data confirm the utility of studying the role of AM in pancreatic cancer, in order to achieve an early diagnosis in high risk populations

Double Trouble – Synchronous Primary Malignant Neoplasms: A Case Report

Synchronous primary malignancy (SPM) is rare. We herein present a case of gastric carcinoma (GC) and renal cell carcinoma (RCC) to highlight the fact that the occurrence of RCC as a synchronous tumor along with GC is rare and that a high index of suspicion of SPM should be considered before declaring it as a metastasis. A 60-year-old male presented with abdominal pain and vomiting for 4 months, and a mass was incidentally found in the lumbar region. The patient was diagnosed with SPM of the GC and RCC. Chemotherapy was given, followed by total gastrectomy; radical nephrectomy was performed. The patient is currently on follow-up. Complete history taking and thorough physical examination of patients with malignancy is instrumental in ruling out metastasis and other synchronous lesions, especially in GC. Synchronous malignancies should be treated with the multidisciplinary team, as there is no consensus in the treatment protoco