Multiple primary cancers of the esophagus and thyroid gland

Synchronous primary esophageal squamous cell carcinoma and gastric adenocarcinoma: analysis of 41 cases treated in a single institution

The present study investigated the treatment and survival outcomes of patients with synchronous primary esophageal squamous cell carcinoma and gastric adenocarcinoma. The medical records of 10,783 patients with primary esophageal squamous cancer treated at our institution between 1995 and 2012 were retrospectively reviewed. Overall survival (OS) rates were calculated using the Kaplan-Meier method. The incidence was 0.38% (41/10,783). Of these 41 patients, 26 underwent curative surgery, ten received palliative chemotherapy or radiotherapy, and five received no treatment. The median OS of the surgery, palliative-therapy, and treatment-free groups was 17.1, 9.0, and 3.8 months, respectively. The 1-, 3-, 5-, and 10-year OS rates for the surgery group were 77%, 45%, 33%, and 19%, respectively. No significant differences in median OS were observed between the surgery group and the historical cohort of isolated esophageal cancer (n = 186) (17.1 vs. 21.0 months, P = 0.061) or isolated gastric cancer (n = 51) (17.1 vs. 28.9 months, P = 0.875), or between the palliative-therapy group and its corresponding historical cohort (n = 30) (9.0 vs. 8.3 months, P = 0.862). The survival outcomes of patients with synchronous primary esophageal squamous and gastric cancers were not worse than those of patients with isolated esophageal cancer or isolated gastric cancer.

Papillary thyroid microcarcinoma with synchronous asymptomatic advanced esophageal squamous cell carcinoma: A case report and review of the literature

Papillary thyroid microcarcinoma (PTMC) is a subset of papillary thyroid carcinoma, with tumors measuring ≤1.0 cm in maximum diameter. Esophageal squamous cell carcinoma (ESCC) is the most common histopathological subtype of the various esophageal malignancies. The present study reports a rare synchronous presentation of PTMC and asymptomatic ESCC manifesting as lateral cervical lymph node enlargement. The patient, a 70-year-old male who presented to the Department of Surgical Oncology, The First Affiliated Hospital of Wenzhou Medical University (Wenzhou, China)with no significant symptoms, was identified to have bilateral thyroid nodules by ultrasonography and enlarged lymph nodes on the left side of the neck by palpation. A diagnosis of PTMC with lateral cervical lymph node metastasis was established and the patient underwent right lobectomy, partial left lobectomy and lymph node biopsy. Pathological analysis of the intraoperative frozen biopsy indicated bilateral PTMC and metastatic lymph node SCC from a different primary location. Furthermore, histological examination of the biopsied lymph nodes revealed bilateral PTMC and poorly-differentiated SCC, which was verified as ESCC by gastroscopy and postoperative histopathological examination. A review of the present literature indicated that no similar case has been reported thus far. The patient succumbed three months after attending Ruijin Hospital, Shanghai Jiao Tong University School of Medicine (Shanghai, China) for additional treatment.

Multidisciplinary treatment based on surgery leading to long-term survival of a patient with multiple asynchronous rare primary malignant neoplasms: A case report and literature review

Patients that present with multiple primary malignant neoplasms are increasingly encountered, but the treatment of such patients presents specific challenges and long-term survival is rare. The present study reports the case of a 45-year-old female diagnosed with three rare, distinct primary malignant neoplasms, including epithelioid hemangioendothelioma (EHE) of the brain, Ewing’s sarcoma of the lumbar 2 vertebra and a malignant solitary fibrous tumour (SFT) of the liver, at different time points. The patient underwent multidisciplinary treatment according to the diagnoses, including radial resection of all primary lesions, chemotherapy (consisting of vincristine, dactinomycin, cyclophosphamide and adriamycin) and radiotherapy, to treat Ewing’s sarcoma and metastases of EHE and malignant SFT. Following these treatments, the patient survived for >14 years. Multidisciplinary treatment regimens based on surgery can lead to long-term survival of patients with multiple asynchronous rare primary malignant neoplasms. The present study reported that multidisciplinary treatment regimens based on surgery can lead to the long-term survival of patients with multiple asynchronous rare primary malignant neoplasms.

Clinicopathologic characteristics of synchronous primary thyroid cancer detected by initial staging 18F-FDG PET-CT examination in patients with underlying malignancy

BACKGROUND

The objective of this study was to define clinicopathologic characteristics in concurrent primary thyroid cancer detected by initial (18)fluorine-fluorodeoxyglucose positron emission tomography-computed tomography ((18)F-FDG PET-CT) scanning in patients with underlying malignancy.

PATIENTS AND METHODS

Among 155 patients with known underlying malignancy and with focal FDG uptake in the thyroid, 25 patients (22 females; mean age ± SD 54.4 ± 11.2 years; age range 27-70 years) who were confirmed as having papillary thyroid cancer (PTC; synchronous thyroid cancer) by cytological examination were included. Another 25 patients (24 females; mean age ± SD, 48.8 ± 12.7 years) with focal uptake in preoperative (18)F-FDG PET-CT due to PTC and no history of other malignancy (primary thyroid cancer) were also included. Immunohistochemical studies were performed for glucose transporter-1 (GLUT-1) and vascular endothelial growth factor (VEGF).

RESULTS

GLUT-1 expression was significantly lower in synchronous thyroid cancer (7 of 25 patients, 28%) compared with primary thyroid carcinoma (15 of 25 patients, 60%; p = 0.045). However, age and tumor size of synchronous thyroid cancer were not significantly different from the patients with primary thyroid carcinomas. There was no significant difference in VEGF expression, maximal standardized uptake values, extrathyroidal extension, lymph node metastasis, advanced stage, and multifocality between both thyroid cancer groups.

CONCLUSION

Clinicopathologic characteristics of synchronous thyroid cancer in patients with underlying malignancy were not different from those of patients with primary thyroid cancers except for GLUT-1 expression.