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Ma J, Zhu J, Yu S, Zhou C, Duan S, Zhang Y. An ileal gastrointestinal stromal tumor misdiagnosed as pelvic metastases from rectal cancer: a case report. Front Oncol 2023; 13:1164391. [PMID: 37182150 PMCID: PMC10166831 DOI: 10.3389/fonc.2023.1164391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 04/05/2023] [Indexed: 05/16/2023] Open
Abstract
With the advancement of imaging and pathological diagnostic methods, it is not uncommon to see synchronous gastrointestinal stromal tumors (GIST) and other primary cancers, the most common of which are synchronous gastric cancer and gastric GIST. However, synchronous advanced rectal cancer and high-risk GIST in the terminal ileum are extremely rare, and they are easily misdiagnosed as rectal cancer with pelvic metastases due to their special location near iliac vessels. Herein, we report a 55-year-old Chinese woman with rectal cancer. Preoperative imaging revealed a middle and lower rectal lesion with a right pelvic mass (considered possible metastasis from rectal cancer). Through multidisciplinary discussions, we suspected the possibility of rectal cancer synchronous with a GIST in the terminal ileum. Intraoperative exploration by laparoscopy revealed a terminal ileal mass with pelvic adhesion, a rectal mass with plasma membrane depression, and no abdominal or liver metastases. Laparoscopic radical proctectomy (DIXON) plus partial small bowel resection plus prophylactic loop ileostomy was performed, and the pathological report confirmed the coexistence of advanced rectal cancer and a high-risk ileal GIST. The patient was treated with the chemotherapy (CAPEOX regimen) plus targeted therapy(imatinib) after surgery, and no abnormalities were observed on the follow-up examination. Synchronous rectal cancer and ileal GIST are rare and easily misdiagnosed as a rectal cancer with pelvic metastases, and careful preoperative imaging analysis and prompt laparoscopic exploration are required to determine the diagnosis and prolong patient survival.
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Affiliation(s)
- Jun Ma
- Department of General Surgery, Anqing Municipal Hospital, Anqing, China
| | - Juan Zhu
- Department of Imaging, Anqing Municipal Hospital, Anqing, China
| | - Shuihong Yu
- Research and Experimental Center, Anqing Medical and Pharmaceutical College, Anqing, China
| | - Chaoping Zhou
- Department of General Surgery, Anqing Municipal Hospital, Anqing, China
| | - Shuqiang Duan
- Department of Pathology, Anqing Municipal Hospital, Anqing, China
| | - Yaming Zhang
- Department of General Surgery, Anqing Municipal Hospital, Anqing, China
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Luo ZH, Qi WL, Jin AF, Liao FX, Liu Q, Zeng QY. The role of 18F-FDG PET/CT in patients with synchronous multiple primary malignant neoplasms occurring at the same time. Front Oncol 2022; 12:1068055. [DOI: 10.3389/fonc.2022.1068055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 11/10/2022] [Indexed: 12/04/2022] Open
Abstract
BackgroundSynchronous multiple primary malignant neoplasms occurring at the same time (SMPMNS) are not currently uncommon in clinical oncological practice; however, the diagnostic performance of 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) for SMPMNS needs further elucidation.PurposeThis study aimed to evaluate the application of 18F-FDG PET/CT in patients with SMPMNS.Materials and methodsThe clinical and imaging data of 37 patients with SMPMNS who had undergone 18F-FDG PET/CT from October 2010 to December 2020 were retrospectively analyzed. The kappa consistency test was applied to evaluate the consistency of the diagnostic performance between PET/CT and conventional imaging (CI). The sensitivity, specificity, and accuracy of PET/CT and CI in the detection of metastatic lesions were compared.ResultsThis retrospective diagnostic study included 74 lesions identified in 37 patients with SMPMNS, with 94.6% of patients having double primary tumors. Of the incidences of SMPMNS, 18.9% occurred in the same organ system, with respiratory tumors being the most common type of neoplasm (43.2%) and the lung being the most common primary site (40.5%). The overall survival of SMPMNS patients without metastases was longer than that of those with metastases (χ2 = 12.627, p = 0.000). The maximum standardized uptake value (SUVmax), the SUVmax ratio (larger SUVmax/smaller SUVmax), and the difference index of SUVmax (DISUVmax) [(larger SUVmax − smaller SUVmax)/larger SUVmax] of the primary lesions ranged from 0.9 to 41.7 (average = 12.3 ± 7.9), from 0.3 to 26.7 (average = 4.4 ± 6.9), and from 0.0% to 96.3% (average = 50.3% ± 29.3%), respectively. With regard to diagnostic accuracy, PET/CT and CI showed poor consistency (κ = 0.096, p = 0.173). For the diagnosis of primary lesions (diagnosed and misdiagnosed), PET/CT and CI also showed poor consistency (κ = 0.277, p = 0.000), but the diagnostic performance of PET/CT was better than that of CI. In the diagnosis of metastases, the patient-based sensitivity, specificity, and accuracy of PET/CT were 100.0%, 81.8%, and 89.2%, respectively, while those of CI were 73.3%, 100.0%, 89.2%, respectively. The sensitivity and specificity values were significantly different, with PET/CT having higher sensitivity (p = 0.02) and CI showing higher specificity (p = 0.02).Conclusions18F-FDG PET/CT improves the diagnostic performance for SMPMNS and is a good imaging modality for patients with SMPMNS.
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Skręt A, Trawińska J, Bielatowicz J, Książek M, Niewęgłowska-Guzik B, Radkowski A, Kargol J, Magierło JS, Barnaś E, Gawlik B. Synchronous occurrence of HPV-associated cervical squamous cell carcinoma (FIGO IIA) in prolapsed uterus and adenocarcinoma of the anal canal cT1N0M0: Case report. Medicine (Baltimore) 2021; 100:e28004. [PMID: 34918650 PMCID: PMC8677995 DOI: 10.1097/md.0000000000028004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 11/11/2021] [Indexed: 11/25/2022] Open
Abstract
RATIONALE Guidelines of rare synchronous tumours treatment are often unavailable due to lack of wide prospective studies. Additionally, their management is not just a simple sum of coexisting tumours management and has to regard many circumstances like symptoms, age, comorbidities, advancement. PATIENT CONCERNS Herein, we report a case of an 81-year-old woman who presented with bleeding from the prolapsed uterus. DIAGNOSES Based on physical examination, that is, speculum examination, bimanual, and per rectum, followed by rectoscopy and histopathology, the diagnosis of cervical squamous cell carcinoma FIGO IIA2 in prolapsed uterus with anal canal adenocarcinoma cT1N0M0 was made. INTERVENTIONS Dominating complaint of bleeding from prolapsed cervix was managed with radical vaginal hysterectomy in conjunction with wide colpectomy preceded by laparoscopic pelvic and paraaortic lymphadenectomy. Due to the lack of consent for removal of the anus, only radiotherapy was applied instead. OUTCOMES The patient underwent magnetic resonance image follow-up. No recurrence was found at 18 months. LESSONS Imaging is useful method of synchronous cancers diagnostics. These cancers may vary in aetiology and stage. Cervical cancer may be co-existing with another anogenital cancer. Therapy of synchronous cancers should be individualized taking into account patient's consent, age, physical condition, and comorbidities.
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Affiliation(s)
- Andrzej Skręt
- Department of Obstetrics and Gynecology with Oncological Gynecology, Health Care Center, Krakowska 91, Dębica, Poland
| | - Joanna Trawińska
- Department of Obstetrics and Gynecology, Frederic Chopin Provincial Clinical Hospital No. 1, Fryderyka Szopena 2, Rzeszow, Rzeszow, Poland
| | - Joanna Bielatowicz
- Department of Obstetrics and Gynecology with Oncological Gynecology, Health Care Center, Krakowska 91, Dębica, Poland
| | - Mariusz Książek
- Clinical Department of Histopathology, St Hedwig the Queen Clinical Provincial Hospital No. 2 in Rzeszow, Lwowska 60, Rzeszow, Poland
| | | | - Andrzej Radkowski
- Radiotherapy Unit with the Department of Radiotherapy, St Luke Provincial Hospital, Lwowska 178a, Tarnow, Poland
| | - Jaromir Kargol
- Department of Radiology and Diagnostic Imaging, Clinical Hospital No1 in Rzeszow, Rzeszow, Poland
| | - Joanna Skręt- Magierło
- Institute of Medical Sciences, Medical College of Rzeszow University, Rejtana 16c, Rzeszow, Poland
| | - Edyta Barnaś
- Institute of Health Sciences, Medical College of Rzeszow University, Rejtana 16c, Rzeszow, Poland
| | - Bogusław Gawlik
- Department of Obstetrics and Gynecology with Oncological Gynecology, Health Care Center, Krakowska 91, Dębica, Poland
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Kurose H, Ueda K, Nakiri M, Matsuo M, Suekane S, Igawa T. Synchronous primary triple urogenital malignant tumors of kidney, prostate and bladder. Urol Case Rep 2020; 33:101277. [PMID: 33101992 PMCID: PMC7573759 DOI: 10.1016/j.eucr.2020.101277] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 05/20/2020] [Accepted: 05/21/2020] [Indexed: 11/25/2022] Open
Abstract
Synchronous occurrence of triple primary cancers of urinary tract is quite rare and represents a difficult treatment challenge. Here, we report a case of a 78-year-old man with synchronous renal cell carcinoma, urothelial carcinoma of urinary bladder and adenocarcinoma of prostate within a short period. To the best of our knowledge, this is the 20th reported of triple primary cancers of urinary tract and the first synchronous case with bone metastasis in the literature.
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Affiliation(s)
- Hirofumi Kurose
- Department of Urology, Kurume University School of Medicine, Kurume, Japan
| | - Kosuke Ueda
- Department of Urology, Kurume University School of Medicine, Kurume, Japan
| | - Makoto Nakiri
- Department of Urology, Kurume University School of Medicine, Kurume, Japan
| | - Mitsunori Matsuo
- Department of Urology, Kurume University School of Medicine, Kurume, Japan
| | - Shigetaka Suekane
- Department of Urology, Kurume University School of Medicine, Kurume, Japan
| | - Tsukasa Igawa
- Department of Urology, Kurume University School of Medicine, Kurume, Japan
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Ghaed MA, Jahanshahi F, Maleki F. The First Report of Triple Advanced Synchronous Cancer: Bladder Transitional Cell Carcinoma and Clinically Silent Adenocarcinoma of Prostate and Colon. Int Med Case Rep J 2019; 12:373-377. [PMID: 31819671 PMCID: PMC6896927 DOI: 10.2147/imcrj.s216410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 11/16/2019] [Indexed: 11/23/2022] Open
Abstract
Multiple synchronous malignancies are believed to be quite rare and their diagnosis and treatment are very challenging for physicians. Co-presence of synchronous bladder and prostate cancers in an elderly individual is not uncommon; however, the simultaneous occurrence of the third cancer - colon cancer - is extremely outlandish. In the present study, the case of an 82-year-old man with a complaint of hematuria is reported who was eventually diagnosed with three synchronous cancers: stage-3 transitional cell carcinoma of the bladder, stage-4 prostate mucinous adenocarcinoma, and stage-3 glandular adenocarcinoma of the colon. The patient underwent total colectomy and radical cystoprostatectomy followed by chemotherapy and radiotherapy. The 2-year follow-up showed promising results with no major complications and the patient's general condition was satisfactory. Although synchronous cancers are not so common, they should not be disregarded in elderly patients especially in those with multiple symptoms.
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Affiliation(s)
- Mohammad Ali Ghaed
- Department of Urology, Rasoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Jahanshahi
- Student Research Committee, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Farid Maleki
- Department of Surgery, Rasoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
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Yoshino A, Kobayashi E, Shiomi M, Sato K, Ichii M, Ueda Y, Kimura T. A successful intraoperative diagnosis of coexisting lymphoma and endometrial cancer. World J Surg Oncol 2019; 17:166. [PMID: 31590673 PMCID: PMC6781389 DOI: 10.1186/s12957-019-1708-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 09/09/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The coexistence of hematological malignancy with endometrial cancer is a rare phenomenon. We report a case of coexistence of endometrial cancer with follicular lymphoma which we suspected preoperatively and diagnosed during surgery by a multidisciplinary intraoperative assessment. CASE PRESENTATION A 67-year-old woman was referred to our hospital due to a suspicion of an endometrial cancer. Endometrial biopsy revealed grade 1 endometrioid adenocarcinoma. MRI showed invasion of the tumor into the outer half of the myometrium, and abdominal CT showed para-aortic and atypical mesentery lymphadenopathy which was suspected to be metastasis of endometrial cancer or malignant lymphoma. Abdominal hysterectomy with bilateral salpingo-oophorectomy, pelvic and para-aortic lymphadenectomy, partial omentectomy, and mesentery lymph node biopsy for endometrial cancer were performed. The mesentery and para-aortic lymph nodes that were sent for frozen section analysis showed no metastasis of the endometrial cancer. We simultaneously conducted an unusual intraoperative emergent four-color flow cytometry and intraoperatively diagnosed a B cell lymphoma in the mesenteric lymph nodes. Because this multidisciplinary assessment, we were able to avoid an unnecessary intestinal resection. The final pathological diagnosis was an endometrioid carcinoma (G1, FIGO stage IA), with a synchronous follicular lymphoma. CONCLUSION Although a rare event in endometrial cancer surgery, it is necessary to be alert to the possibility of a synchronous lymphoma in cases of unusual site adenopathy.
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Affiliation(s)
- Ai Yoshino
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, 2-2, Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Eiji Kobayashi
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, 2-2, Yamadaoka, Suita, Osaka, 565-0871, Japan.
| | - Mayu Shiomi
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, 2-2, Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Kazuaki Sato
- Department of Pathology, Osaka University Graduate School of Medicine, 2-2, Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Michiko Ichii
- Department of Hematology and Oncology, Osaka University Graduate School of Medicine, 2-2, Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Yutaka Ueda
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, 2-2, Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Tadashi Kimura
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, 2-2, Yamadaoka, Suita, Osaka, 565-0871, Japan
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