Non-familial double malignancy of the colon and ampulla of Vater: a case report and review of literature

Synchronous primary duodenal papillary adenocarcinoma and gallbladder carcinoma: A case report and review of literature

BACKGROUND

Synchronous primary cancers (SPCs) have become increasingly frequent over the past decade. However, the coexistence of duodenal papillary and gallbladder cancers is rare, and such cases have not been previously reported in the English literature. Here, we describe an SPC case with duodenal papilla and gallbladder cancers and its diagnosis and successful management.

CASE SUMMARY

A 68-year-old Chinese man was admitted to our hospital with the chief complaint of dyspepsia for the past month. Contrast-enhanced computed tomography of the abdomen performed at the local hospital revealed dilatation of the bile and pancreatic ducts and a space-occupying lesion in the duodenal papilla. Endoscopy revealed a tumor protruding from the duodenal papilla. Pathological findings for the biopsied tissue revealed tubular villous growth with moderate heterogeneous hyperplasia. Surgical treatment was selected. Macroscopic examination of this surgical specimen revealed a 2-cm papillary tumor and another tumor protruding by 0.5 cm in the gallbladder neck duct. Intraoperative rapid pathology identified adenocarcinoma in the gallbladder neck duct and tubular villous adenoma with high-grade intraepithelial neoplasia and local canceration in the duodenal papilla. After an uneventful postoperative recovery, the patient was discharged without complications.

CONCLUSION

It is essential for clinicians and pathologists to maintain a high degree of suspicion while evaluating such synchronous cancers.

A single centre study from western India to evaluate the frequency of developing second and subsequent multiple primary malignancies among cancer survivors

Aim

This study was designed to evaluate the frequency of developing second and subsequent primary cancers among cancer survivors.

Methods

We have retrospectively analyzed 121 multiple primary cancer patients treated at Bhagwan Mahavir Cancer Hospital and Research Centre, Jaipur, Rajasthan, India from the last 20 years. The survival analysis was performed by Kaplan-Meier methodology.

Results

The prevalence of multiple primary malignant tumors (MPMTs) was 1.51% (121/8000), with a male to female ratio of 1:1.42. In males most of the reported MPMTs were synchronous and most common first primary cancer cases were head & neck and lung whereas, in females most of the reported MPMTs were metachronous and most common first primary cancer cases were breast and gynaecological malignancies. Family history was reported in 15 cases. Maximum 33.05% patients received combined treatment of chemotherapy, radiotherapy and 91.73% (111/121) of patients with MPMTs were effectively followed up, 35 (28.92%) patients died and 5-year survival rate of the remaining 86 patients was 68.46%.

Conclusions

In the present observational study the most frequent sites of MPMTs in men were head & neck and lung whereas, in women breast and gynaecological sites were common. Therefore, careful monitoring and follow up are required for these patients.

Screening for colorectal cancer after pancreatoduodenectomy for ampullary cancer

BACKGROUND

In some Dutch pancreatic surgery centers, patients who underwent pancreatoduodenectomy (PD) for ampullary cancer undergo surveillance for colorectal cancer (CRC), since an association is suggested in contemporary literature. This study aimed to examine the CRC incidence after PD for ampullary cancer in four pancreatic surgery centers and a Dutch nationwide cohort.

METHODS

All patients who underwent resection of ampullary cancer from 2005 through 2017 at four centers were included. All colonoscopies and CRC diagnoses in these patients were recorded. In addition all PDs for ampullary cancer in the Dutch Pathology Registry (2000-2017) were recorded along with the CRC diagnoses and compared with an age, sex, and year-matched cohort.

RESULTS

Out of 287 included patients by the four centers, 11% underwent a colonoscopy within one year after PD. Eight (2.7%) were diagnosed with CRC before PD and two (0.7%), at 14 and 72 months after PD. In the nationwide cohort comparison, the CRC incidence was similar before (2.6% versus 1.9%, P = 0.424) and after surgery (2.1% versus 3.1%, P = 0.237). Within one year after PD, the incidence was 0.3% compared to 0.6% in the matched controls (P = 0.726).

CONCLUSIONS

The current study could not find an increased risk of CRC in patients with resected ampullary cancer. Therefore, there is insufficient justification to screen for CRC in patients with resected ampullary cancer.

Multiple primary cancers: An enigma

Background:

Incidence of multiple primary cancers though uncommon, is being frequently reported now-a-days owing to better diagnostic techniques, the prolonged life span and the increased incidence of long-term survival of cancer patients.

Materials and Methods:

This is a retrospective study. Cases of multiple malignancies diagnosed histopathologically were retrieved from the archives of department of surgical oncology. Clinical data were obtained from the medical records. They were categorized as synchronous malignancies if the interval between them was less or equal to 6 months and metachronous, if the interval was more than 6 months.

Results:

A total of 13 cases were encountered in the 5 year study period. Out of them two were in the metachronous category and the rest were synchronous as the 2^nd malignancy was detected mostly during clinical evaluation of the patients for the primary malignancy. There was female predominance with age range being 43-68 years. Majority of the cases were in the 7^th decade. The most common organ involved was breast, followed by cervix. Apart from bilateral breast malignancies, there were combinations like breast with uterine endometrial carcinoma, cervical carcinoma and even papillary thyroid carcinoma.

Conclusion:

Detection of multiple primary malignancies is becoming increasingly common in day-to-day practice. Greater awareness of this is required among both cancer patients and their treating clinicians.