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Sumiya R, Ito K, Takemura N, Miyazaki H, Arakawa R, Kato N, Aozasa N, Mihara F, Kokudo N. Seventeen primary malignant neoplasms involving the skin, ovary, esophagus, colon, oral cavity, and ear canal: a case report and review of the literature. Clin J Gastroenterol 2021; 14:980-987. [PMID: 34019222 DOI: 10.1007/s12328-021-01444-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Accepted: 05/15/2021] [Indexed: 12/01/2022]
Abstract
Multiple primary malignant neoplasm (MPMN) is a rare disease with two or more malignant neoplasms in one patient. In less than 0.1% of cancer patients, four or more occur. MPMN is frequently associated with hereditary cancer syndrome, although in rare cases, it is not. A female patient developed 17 MPMNs. Although they were successfully treated with surgery, radiation, and adjuvant chemotherapy, the patient died from the recurrence of ovarian cancer. To explore genetic susceptibility to MPMN, immunohistochemical analysis, microsatellite instability analysis, germ line exome sequencing, and unscheduled DNA synthesis assays were performed. However, the results of immunohistochemical analysis and microsatellite instability indicated that there were no known hereditary cancer syndromes, and exome sequencing with 88 representative genes associated with hereditary cancer syndrome revealed no variants. An unscheduled DNA synthesis assay to rule out xeroderma pigmentosum was also performed, but the result was negative. While the presence of multiple neoplasms is rare, the present case represents 17 primary neoplasms with no associations with hereditary cancer syndrome. Although the cause of MPMN was not detected in this patient, careful follow-up and deliberate cancer screening enabled successful disease management over 17 years from the appearance of the first neoplasm.
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Affiliation(s)
- Ryusuke Sumiya
- Department of Surgery, National Center for Global Health and Medicine, Hepato-Biliary-Pancreatic Surgery Division, 1-21-1 Toyama, Shinjuku-ku, Tokyo, 162-8655, Japan
| | - Kyoji Ito
- Department of Surgery, National Center for Global Health and Medicine, Hepato-Biliary-Pancreatic Surgery Division, 1-21-1 Toyama, Shinjuku-ku, Tokyo, 162-8655, Japan
| | - Nobuyuki Takemura
- Department of Surgery, National Center for Global Health and Medicine, Hepato-Biliary-Pancreatic Surgery Division, 1-21-1 Toyama, Shinjuku-ku, Tokyo, 162-8655, Japan.
| | - Hideki Miyazaki
- Pathology Division of Clinical Laboratory, National Center for Global Health and Medicine, Tokyo, Japan
| | - Reiko Arakawa
- Medical Genomics Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Norihiro Kato
- Medical Genomics Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Naohiko Aozasa
- Department of Dermatology, National Center for Global Health and Medicine, Tokyo, Japan
| | - Fuminori Mihara
- Department of Surgery, National Center for Global Health and Medicine, Hepato-Biliary-Pancreatic Surgery Division, 1-21-1 Toyama, Shinjuku-ku, Tokyo, 162-8655, Japan
| | - Norihiro Kokudo
- Department of Surgery, National Center for Global Health and Medicine, Hepato-Biliary-Pancreatic Surgery Division, 1-21-1 Toyama, Shinjuku-ku, Tokyo, 162-8655, Japan
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Muto Y, Suzuki K, Kato T, Ichida K, Takayama Y, Fukui T, Kakizawa N, Watanabe F, Kaneda Y, Noda H, Rikiyama T. Multiple primary malignancies of six organs in a Japanese male patient: A case report. Mol Clin Oncol 2019; 10:511-515. [PMID: 30967945 DOI: 10.3892/mco.2019.1819] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Accepted: 02/18/2019] [Indexed: 12/27/2022] Open
Abstract
As a result of recent advances in diagnostic techniques and treatment modalities, the number of patients diagnosed with multiple primary malignancies has been increasing. We report the case of a 79-year-old male with multiple primary malignancies of three histological types in six different organs: Stomach, prostate, colon, urinary bladder, facial skin and pancreas, in chronological order. The first malignancy was upper gastric cancer diagnosed in 1998. The second and third malignancies were prostate cancer and ascending colon cancer, which were diagnosed in 2010. The fourth malignancy was bladder cancer diagnosed in 2011. The fifth and sixth malignancies were squamous cell skin cancer of the right cheek and intraductal papillary mucinous carcinoma (IPMC), respectively, diagnosed in 2014. The gastric cancer, colon cancer, bladder cancer, skin cancer and IPMC were surgically resected. The prostate cancer was treated by anti-androgen therapy. The patient died of local recurrence of IPMC in August 2016. Although multiple primary malignancies are not uncommon, diagnosis of six primary malignancies in a single patient, as reported in the present study, is extremely rare. It is important to understand the characteristics of multiple primary malignancies in order to administer suitable treatment and determine relevant follow-up plans for patients with cancer.
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Affiliation(s)
- Yuta Muto
- Department of Surgery, Saitama Medical Center, Jichi Medical University, Omiya-ku, Saitama 330-8503, Japan
| | - Koichi Suzuki
- Department of Surgery, Saitama Medical Center, Jichi Medical University, Omiya-ku, Saitama 330-8503, Japan
| | - Takaharu Kato
- Department of Surgery, Saitama Medical Center, Jichi Medical University, Omiya-ku, Saitama 330-8503, Japan
| | - Kosuke Ichida
- Department of Surgery, Saitama Medical Center, Jichi Medical University, Omiya-ku, Saitama 330-8503, Japan
| | - Yuji Takayama
- Department of Surgery, Saitama Medical Center, Jichi Medical University, Omiya-ku, Saitama 330-8503, Japan
| | - Taro Fukui
- Department of Surgery, Saitama Medical Center, Jichi Medical University, Omiya-ku, Saitama 330-8503, Japan
| | - Nao Kakizawa
- Department of Surgery, Saitama Medical Center, Jichi Medical University, Omiya-ku, Saitama 330-8503, Japan
| | - Fumiaki Watanabe
- Department of Surgery, Saitama Medical Center, Jichi Medical University, Omiya-ku, Saitama 330-8503, Japan
| | - Yuji Kaneda
- Department of Surgery, Saitama Medical Center, Jichi Medical University, Omiya-ku, Saitama 330-8503, Japan
| | - Hiroshi Noda
- Department of Surgery, Saitama Medical Center, Jichi Medical University, Omiya-ku, Saitama 330-8503, Japan
| | - Toshiki Rikiyama
- Department of Surgery, Saitama Medical Center, Jichi Medical University, Omiya-ku, Saitama 330-8503, Japan
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Arakawa K, Hata K, Yamamoto Y, Nishikawa T, Tanaka T, Kiyomatsu T, Kawai K, Nozawa H, Yoshida M, Fukuhara H, Fujishiro M, Morikawa T, Yamasoba T, Koike K, Fukayama M, Watanabe T. Nine primary malignant neoplasms-involving the esophagus, stomach, colon, rectum, prostate, and external ear canal-without microsatellite instability: a case report. BMC Cancer 2018; 18:24. [PMID: 29301504 PMCID: PMC5753511 DOI: 10.1186/s12885-017-3973-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Accepted: 12/21/2017] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Although cases of multiple primary malignant neoplasms are increasing, reports of more than three or four primary metachronous malignant neoplasms are extremely rare. Moreover, very few publications have provided a genetic mutational analysis or have evaluated risk factors associated with such neoplasms. We present an extremely rare case of nine primary malignant lesions in a man who was successfully treated. We also report on microsatellite stability status, analyze risk factors, and discuss the relevant literature. CASE PRESENTATION Between 67 and 73 years of age, a male patient developed nine primary metachronous malignant lesions: Three were located in the esophagus, two in the stomach, two in the colorectum, one in the prostate gland, and one in the external ear canal. The patient's clinical history included hypertension, atrial fibrillation, an acoustic schwannoma, and heavy smoking. The lesions were diagnosed during regular screening over a six-year period. He was successfully treated with surgery (both open surgical and endoscopic resection of lesions) and adjuvant chemotherapy. Immunohistochemistry and mutational analysis showed that the lesions were microsatellite stable, and the KRAS, BRAF, p53, and nuclear β-catenin status was not uniform among the lesions. CONCLUSIONS Given that the presence of more than three or four neoplasms is extremely rare, the present case of nine primary malignancies with no associated microsatellite instability and no apparent predisposing hereditary conditions, is extraordinary. Our case study shows that it is possible for up to nine sporadic neoplasms to occur, and efficient disease management requires diligent screening and early detection.
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Affiliation(s)
- Keiichi Arakawa
- Department of Surgical Oncology, the University of Tokyo, Tokyo, Japan
- Department of Surgical Oncology, University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033 Japan
| | - Keisuke Hata
- Department of Surgical Oncology, the University of Tokyo, Tokyo, Japan
| | - Yoko Yamamoto
- Department of Surgical Oncology, the University of Tokyo, Tokyo, Japan
| | - Takeshi Nishikawa
- Department of Surgical Oncology, the University of Tokyo, Tokyo, Japan
| | - Toshiaki Tanaka
- Department of Surgical Oncology, the University of Tokyo, Tokyo, Japan
| | | | - Kazushige Kawai
- Department of Surgical Oncology, the University of Tokyo, Tokyo, Japan
| | - Hiroaki Nozawa
- Department of Surgical Oncology, the University of Tokyo, Tokyo, Japan
| | - Masafumi Yoshida
- Department of Otolaryngology, the University of Tokyo, Tokyo, Japan
| | | | | | - Teppei Morikawa
- Department of Pathology, the University of Tokyo, Tokyo, Japan
| | - Tatsuya Yamasoba
- Department of Otolaryngology, the University of Tokyo, Tokyo, Japan
| | - Kazuhiko Koike
- Department of Gastroenterology, the University of Tokyo, Tokyo, Japan
| | | | - Toshiaki Watanabe
- Department of Surgical Oncology, the University of Tokyo, Tokyo, Japan
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Xia X, Cui K. A recommendation for the management of lesions of unknown malignancy in multiple primary malignant neoplasm patients: A case report. Oncol Lett 2014; 8:2744-2746. [PMID: 25364458 PMCID: PMC4214459 DOI: 10.3892/ol.2014.2601] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2013] [Accepted: 04/29/2014] [Indexed: 02/05/2023] Open
Abstract
In numerous patients with multiple primary malignant neoplasms, it is difficult to determine whether the mass is benign or malignant, and the method to treat these lesions is controversial. For patients with a history of cancer, a point of high-risk for the development of a second primary tumor occurs following a 10-year gap. To the best of our knowledge, to date, there has been no large clinical trial to observe the appropriate method to manage the lesions in patients with multiple primary malignant neoplasms. The present study reports the case of a patient who was initially diagnosed with rectal cancer, treated with Dixon’s rectectomy and post-operative chemotherapy. The patient’s disease was evaluated as complete response following these treatments. However, the patient then presented with bladder cancer and underwent transurethral resection of the bladder tumor, again achieving a complete response. The patient more recently presented with hepatocellular carcinoma, which developed from an unexplained mass in the liver. The patient underwent partial liver resection and to date, has achieved a complete response. The management of masses of unknown malignancy is also discussed. The current case provides useful insight for future research in this field.
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Affiliation(s)
- Xiangyu Xia
- Cancer Center, West China Hospital, West China Medical School, Chengdu, Sichuan 610041, P.R. China
| | - Kaijun Cui
- Department of Cardiology, West China Hospital, West China Medical School, Chengdu, Sichuan 610041, P.R. China ; State Key Laboratory of Biotherapy, Sichuan University, Chengdu, Sichuan 610041, P.R. China
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Komiyama S, Nishio E, Ichikawa R, Miyamura H, Kawamura K, Komiyama M, Nishio Y, Udagawa Y. Asymptomatic synchronous quintuple primary cancers. Gynecol Obstet Invest 2012; 74:324-8. [PMID: 22776788 DOI: 10.1159/000339135] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2011] [Accepted: 04/25/2012] [Indexed: 11/19/2022]
Abstract
We encountered a 46-year-old woman with synchronous quintuple primary cancers. She did not present with any symptoms, and her tumors were discovered at a gynecological screening. She had clear cell adenocarcinoma of the right ovary, moderately differentiated endometrioid adenocarcinoma of the endometrium, moderately differentiated adenocarcinoma of the ascending colon, well-differentiated adenocarcinoma of the rectum, and poorly differentiated papillary adenocarcinoma of the left lung. A fluorodeoxyglucose-positron emission tomography and other imaging techniques were extremely useful for the diagnosis of multiple primary cancers. Moreover, MSH2 protein expression was absent in the tumors of the ovary, endometrium, ascending colon, and rectum, while the rectal cancer also lacked MLH1 protein. These findings suggested that an abnormality of DNA mismatch repair genes was responsible for carcinogenesis.
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Affiliation(s)
- Shinichi Komiyama
- Department of Obstetrics and Gynecology, Fujita Health University School of Medicine, Toyoake, Japan.
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