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Multiple Primary Malignant Neoplasms (MPMNs) are rarely reported and are defined as the diagnosis of ?2 independent, primary malignancies of different histologies/ origins in a single individual. In this study, we report a patient with Male Breast Cancer (MBC) and coexisting Small Lymphocytic Lymphoma (SLL) and Chronic Lymphocytic Leukemia (CLL). A 65-year-old male with complaints of a lump in his left breast since 2 years. CT scan findings were a non-homogeneous mass in the left breast along with bilateral axillary lymphadenopathy. Modified radical mastectomy was done. Microscopic examination showed the features of infiltrating duct carcinoma NOS: Modified Nottingham Bloom Richardson抯 Grade II in breast specimen. A peripheral smear of the patient showed features of chronic lymphocytic leukemia (absolute lymphocyte count was 16400 cells/mm3). IHC of breast tumor showed ER/PR positivity with H scores of 350 and 240 respectively and HER- 2/Neu protein expression was negative with a score of (1+). Lymph nodes were immunoreactive for CD 19, CD 23 and CD 5. Cells were non-reactive for Cyclin D1a and CD3. This is probably the first case of MBC with SLL and CLL. The diagnosis is consistent with synchronous MPMNs, which are increasingly reported nowadays.
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@#Primary malignant melanoma of the esophagus (PMME) is an exceptionally rare condition, representing a mere 0.1 to 0.2% of esophageal cancers, and accounting for just 0.1 to 0.5% of all melanomas. This case involves a 39 -year-old Filipino male who sought medical attention after an episode of choking. Subsequently, endoscopy with biopsy revealed a mass in the distal third of the esophagus, ultimately diagnosed as PMME based on histopathology and immunohistochemistry. FDG-PET/CT scan revealed a hypermetabolic distal esophageal mass and a confluent upper paratracheal lymphadenopathy. He was initially treated with Pembrolizumab, Nivolumab, and Ipilimumab immunotherapy. However, post-treatment FDG PET/CT scans unveiled metabolic progression of the esophageal mass with new hypermetabolic cervical lymph nodes, necessitating a shift to carboplatin and paclitaxel chemotherapy. After two cycles, there was a notable metabolic regression of the mass and paratracheal node with metabolic resolution of the cervical lymph node. An additional 2 cycles of chemotherapy were given, aimed to further reduce the size of the tumor, however, a succeeding follow-up study revealed metabolic progression of the mass. Surgical resection of both the esophageal mass and paratracheal nodes became imperative. The aggressive characteristics, metastasis at early diagnosis, and lack of effective treatment have contributed to the poor prognosis of PMME. Total esophagectomy is the preferred method of treatment. Chemotherapy and immunotherapy may be used in advanced diseases but with variable efficacy. The utilization of FDG PET/CT scans plays a crucial role in both the initial staging and the ongoing assessment of treatment response in patients diagnosed with PMME. This advanced imaging modality offers valuable insights into the extent of the disease and aids clinicians in evaluating the effectiveness of the chosen therapeutic interventions. Given the rarity and challenges associated with PMME, a multidisciplinary approach integrating surgical, medical, and imaging strategies is essential for comprehensive patient care.
Subject(s)
Melanoma , Positron-Emission Tomography , Fluorodeoxyglucose F18 , ImmunotherapyABSTRACT
【Objective】 To provide reference for formulating preoperative blood preparation plan for malignant osteosarcoma scientifically and rationally under the persistent COVID-19 epidemic by studying the high-risk influencing factors related to intraoperative blood transfusion in patients with primary malignant osteosarcoma. 【Methods】 The general data, preoperative blood routine and coagulation parameter, clinicopathological record and surgical data of 120 patients with primary malignant osteosarcoma in Beijing Jishuitan Hospital from January 2020 to January 2021 were retrospectively analyzed by univariate analysis, multivariate regression analysis and Pearson correlation analysis to determine the high risk factors for intraoperative blood transfusion in patients with primary malignant osteosarcoma. 【Results】 The incidence of intraoperative and postoperative blood transfusion of malignant osteosarcoma patients were 48.33% (58/120) and 62.50% (75/120), with the average blood transfusion units at (1.36±1.14) U and (2.93±2.26) U, respectively. The univariate analysis showed that such factors as sex, preoperative Hct (%), preoperative Plt (×109/L), location of lesion, Huvos classification, incision length (cm), reconstruction length(cm) and intraoperative blood loss (mL) were significantly different (P<0.05). Multivariate logistic regression analysis showed that sex, location of lesion, Huvos classification, incision length (cm), reconstruction length(cm) and intraoperative blood loss (mL) were significantly different (P<0.05). 【Conclusion】 For primary malignant osteosarcoma with a high rate of intraoperative blood transfusion, early intervention should be carried out according to the high-risk factors of intraoperative blood transfusion, and preoperative blood preparation plan should be accurately formulated to effectively reduce the rate and units of blood transfusion in patients under the premise of surgery safety.
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Objective@#To investigate the clinicopathological features, treatment and prognosis of oralmucosal malignant melanoma to provide a reference for clinical practice.@*Methods@#Data from 19 patients with oralmucosal malignant melanoma were collected, and their clinical manifestations, treatment methods and follow-up results were retrospectively analyzed. @*Results@#Among the 19 patients, 11 cases (58%) had lesions in the gingiva, 7 cases (37%) had lesions in the palate, and 1 case (5%) had lesions in the tongue, the difference was statistically significant (P<0.05). Eight patients had regional lymph node metastasis with a metastasis rate of 42%, of which 4 cases had multiple site metastasis, and the total number of regional lymph node metastasis sites was 15. Among the 19 patients, 3 cases received only surgery, 4 cases received cryotherapy, and 12 cases received combined surgery, cryotherapy and biological immunotherapy. Pathological examination showed malignant melanoma. The positive rates of S-100, HMB-45 and Melan-A were 95%, 89% and 84%, respectively. Kaplan-Meier survival analysis showed that patients with lesions less than 5 cm2 had a higher survival rate (P < 0.05).@*Conclusions@# Oral malignant melanomas usually present as black lesions in the oral mucosa, which are prone to metastasis in early stage. The area of lesions may affect the prognosis of the disease. Therefore, the large range of black lesions or masses should be the alert for the clinicians. Oral malignant melanoma patients are usually treated with combined treatment with surgery, cryotherapy and biological immunotherapy.
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Primary malignant melanoma of the vagina is a rare and aggressive disease with worse prognosis as compared with non-genital melanomas or other vaginal malignant neoplasms. Presented here is a case of 42 years female with 3 months history of amenorrhea and vaginal discharge. On vaginal examination, a firm growth of size approximately 7-8 cm was found attached to the left postero-lateral wall of vagina and extending up to the introitus. On biopsy and histopathological examination, it was diagnosed as a case of high-grade malignant melanoma of amelanotic type. Radiotherapy was started as a part of treatment after consultation with an oncologist, considering non-resectable nature of the mass. The patient received first 5 cycles of radiotherapy but succumbed to the disease during treatment.
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Objective@# To investigate the diagnosis and treatment of synchronous double primary malignant tumours of the tongue and lung.@*Methods@#A case of adenoid cystic carcinoma（ACC） and lung adenocarcinoma with double primary malignancy was retrospectively analyzed.@*Results@#The tumor of patient′s tongue base gradually grew. MRI showed multiple enlarged lymph nodes on both sides of neck. CT of the chest showed obvious lesions in the anterior basal segment of the right lower lobe. The pathological biopsy of the tongue mass identified ACC, and pathological biopsy of the lung mass identified lung adenocarcinoma. The tongue and lung tumors were both surgically resected, and the tongue defect was repaired at the same time. No residue was found after surgery, and no recurrence was found during the follow-up period. The aesthetic and functional restoration of the lingual region was good.@*Conclusion@#There are few cases of adenoid cystic carcinoma and lung adenocarcinoma with double primary malignancies, and the related diagnosis and treatment are very difficult; the simultaneous removal of double primary malignant tumors may achieve good prognosis.
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Objective: To investigate the surgical method for primary malignant osseous tumors in the craniovertebral junction (CVJ) and its effectiveness. Methods: The clinical data of 7 patients with primary malignant osseous spinal tumors in CVJ, which collected between September 2010 and April 2019, were retrospectively analyzed. There were 5 males and 2 females, aged 23 to 75 years (median, 56 years). All patients were diagnosed as chordoma in 4 cases, plasmacytoma in 2 cases, and fibrosarcoma in 1 case. The disease duration ranged from 0.7 to 36.0 months, with an average of 12.2 months. Lesion location: 1 case of C 0, 1, 3 cases of C 2, 1 case of C 1, 2, 1 case of C 2, 3, and 1 case of C 0-2. Preoperative visual analogue scale (VAS) score was 6.7±2.1, the Japanese Orthopaedic Association (JOA) score was 15.6±2.4. According to American Society of Spinal Cord Injury (ASIA) grading system, there was 1 case of grade C, 1 case of grade D, and 5 cases of grade E. According to Enneking stage of spinal malignant tumor, there was 1 case of stage ⅠB, 2 cases of stage ⅡB, and 4 cases of stage Ⅲ. According to Weinstein-Boriani-Biagini (WBB) stage, there was 1 case of 5-8/A-D, 1 case of 4-9/A-D, 1 case of 6-7/B-D, 1 case of 6-7/A-D, 2 cases of 1-12/A-D, and 1 case of 3-10/A-D. All these patients were treated with tumor extended resection, bone graft fusion, and internal fixation via posterior cervical approach, as well as tumor (stage Ⅰ or stage Ⅱ) boundary resection via transoral or submandibular approach. Meanwhile, anterior reconstructive fusion was procedured with bone grafting Cage needed to place the internal fixation. Results: The operation time was 307-695 minutes (mean, 489.57 minutes), and the intraoperative blood loss was 400-2 000 mL (mean, 1 107.14 mL). There was no intraoperative injury in vertebral artery and spinal cord or any related postoperative complications, including incision infection, intracranial infection, and pulmonary infection. All the patients were followed up 3-57 months (mean, 21 months). Postoperative X-ray film and CT showed that the internal fixation screw was firm and in a satisfactory position, and the bone graft was fused at 3-6 months after operation. Symptoms such as neck pain, limb numbness, and fatigue relieved to different degrees after operation. At 3 months after operation, the VAS score improved to 1.7±0.8 ( t=7.638, P=0.000); while the JOA score improved to 16.1±1.5, but no significant difference was found when compared with preoperative score ( t=1.549, P=0.172). According to ASIA grading system, 1 patient with grade C had upgraded to grade D after operation, while the remaining patients had no change. There were 4 cases of recurrence after operation, in which those patients were with high malignancy of tumors before the first surgery. Their tumors also affected a wide range of slope or surrounding soft tissues and could not be completely removed. Among the 4 cases, 1 patient underwent transoral tumor removal operation again, while the other 3 cases gave up further treatment. There was no recurrence among the remaining 3 cases. Conclusion: Primary malignant osseous tumors in the CVJ can be completely exercised via means of trabsoral or submandibular approach. Meanwhile the anterior reconstruction can be achieved by placing special Cage specimen. These two methods together with postoperative adjuvant treatments such as radiotherapy and chemotherapy can improve the survival time of patients and reduce tumor recurrence.
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Primary malignant melanoma of the uterine cervix is a rare neoplasm and the overall prognosis of patients with this disease is very poor. Herein, authors report a case of 45-year-old woman who presented with vaginal bleeding for one months and examination showed an exophytic, 6 cm polypoid blackish-pigmented tumor on the cervix involving vaginal fornix. She underwent abdominal radical hysterectomy with bilateral salpingo-oophorectomy and pelvic lymphadenectomy and further received adjuvant concurrent chemo-radiation with cisplatin (CDDP) and temozolamide but died 7 months after surgery.
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Primary malignant fistulas of the gastro-intestinal tract are very rare. Usually they are secondary to diverticular disease, crohn'sgastric ulcer, lymphoma, post surgery etc. Here we have reported a very rare case of primary malignant fistula with primarylocated at recto-sigmoid junction, leading to a fistulous tract between the jejunum and sigmoid colon. We have briefed on thecourse of the disease, investigations done and management of the same.
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Objective: To assess the effectiveness of the pasteurized tumor-bearing bone replantation in treatment of primary malignant bone tumor of extremities. Methods: Between February 2012 and June 2016, 13 patients with primary malignant bone tumor of extremities were treated with pasteurized tumor-bearing bone replantation after extensive excision. There were 8 males and 5 females, aged from 11 to 27 years, with an average of 17.4 years. Tumors were located at the mid-upper humerus in 2 cases, the mid-upper femur in 2 cases, the mid-lower femur in 6 cases, the mid-upper tibia in 2 cases, and the middle tibia in 1 case. According to Enneking staging system, 3 patients were classified as stage ⅠB, 5 patients as stage ⅡA, and 5 patients as stage ⅡB. There were 11 cases of osteosarcoma and 2 cases of chondrosarcoma. The disease duration ranged from 3 to 8 months, with an average of 4.8 months. The length of the tumor-bearing bone ranged from 8 to 16 cm, with an average of 12.5 cm. Postoperative follow-up was conducted regularly to evaluate the status of inactivated bone and complications. The limb function was assessed by the Musculoskeletal Tumor Society 93 (MSTS-93) scoring system. Results: All 13 patients were followed up 26-79 months, with an average of 50.5 months. Eleven patients survived without tumors. Two patients had local soft tissue recurrence and underwent amputation, 1 had lung metastasis after amputation and died. All patients had no complications of bone resorption, shortening, and internal fixation disorder. The nonunion of osteotomy occurred in 4 cases. Among them, 3 cases were successfully healed after autologous iliac bone grafting, and 1 case was treated conservatively. The healing time of metaphyseal osteotomy end was 10-15 months (mean, 12.6 months), the healing rate was 90.9% (10/11); the healing time of diaphyseal osteotomy end was 12-21 months (mean, 17.0 months), the healing rate was 72.7% (8/11); and the total healing rate of osteotomy end was 81.8% (18/22). One case had inactivated bone fracture and 1 case had incision dehiscence and infection after operation. At last follow-up, the MSTS-93 score of affected limb ranged from 21 to 28, with an average of 25.3. Conclusion: The procedure of the pasteurized tumor-bearing bone replantation is an effective, simple, and economic way in repair of massive segmental bone defect to save limb function for primary malignant bone tumor of extremities.
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Primary malignant melanoma (PMM) of the gastrointestinal tract is rare. Reported cases of PMM of the lower gastrointestinal tract typically describe anal and rectal involvement rather than colonic lesions. This report describes a rare case of a 50-year-old woman with PMM originating in the colon. The patient presented to Inje University Busan Paik Hospital with a 3-day history of blood-tinged stools. She underwent colonoscopy for a diagnosis of hematochezia. The colonoscopic examination revealed a large-sized semi-pedunculated sigmoid colon polyp with a reddish-colored mucosal surface. Endoscopic mucosal resection was performed, and the final histopathological findings were consistent with a diagnosis of malignant melanoma. Systemic work-up was performed for assessment of metastasis and to identify the primary tumor considering the high metastatic rate of gastrointestinal malignant melanoma; however, no other malignant lesion was detected. Thus, she was diagnosed with colonic PMM. She underwent laparoscopic low anterior resection and lymph node dissection and has been recurrence-free for > 2 years.
Subject(s)
Female , Humans , Middle Aged , Colon , Colon, Sigmoid , Colonoscopy , Diagnosis , Gastrointestinal Hemorrhage , Gastrointestinal Tract , Lower Gastrointestinal Tract , Lymph Node Excision , Melanoma , Melanosis , Neoplasm Metastasis , PolypsABSTRACT
Malignant melanoma arises from either melanocytes or their precursor cells, melanoblasts. As melanocytes are found in normal leptomeningeal tissue, it is not surprising that primary melanomas can grow within the central nervous system. Primary intracranial melanoma is uncommon and accounts for only approximately 1% of all cases of melanoma. It is difficult to diagnose a primary CNS melanoma upfront. Here, we are presenting a rare case of primary malignant melanoma in left frontoparietal area in 65 years old male patient. This case provides us with a good learning opportunity, which is to increase recognition and awareness of rare entity of primary malignant melanoma.
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@#Diffuse large B-cell lymphoma (DLBCL) is the most common subtype of non-hodgkin’s lymphoma (NHL), which has a wide range in age of onset, and has obvious heterogeneity in clinical features, invasive areas, histomorphology, molecular genetics and immune phenotype. In addition, with the improvement of the diagnosis and treatment of malignant tumor, the report of multiple primary malignant tumors (MPMT) in the same patient is on the rise. This paper reports a case of DLBCL combined with thyroid neoplasms with paraplegia as the clinical manifestation.
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Malignant melanoma is a highly malignant tumor that is derived from melanocytes. The incidence of malignant melanoma has risen markedly over the last decade. Malignant melanoma mostly occurs in the skin, mucous membranes and the choroid. The cases of primary melanoma of the breast are quite rare. Observation of the clinical pathological features, immunohistochemical staining methods and tissue origin are required to identify primary malignant melanoma of the breast. This case report of primary malignant melanoma is presented because of its rarity.
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Objective To analyze the CT and MR manifestations and the diagnosis of primary malignant melanoma in the nasal cavity and paranasal sinuses.Methods CT,MR features and clinical data of 1 6 cases of malignant melanoma in the nasal cavity and paranasal sinuses,which were confirmed by biopsy or surgical pathology and immunohistochemistry were analysed retrospectivelly. CT routine and enhanced scan were performed in all patients,MR routine and enhanced scan were performed in 9 cases.Results CT findings of 1 6 patients were unilateral,in which 8 cases were located in the nasal cavity,4 cases in the paranasal sinuses,and 4 cases were both in the nasal cavity and paranasal sinuses.All lesions were irregular shape with soft tissue densityand without calcification and cystic degeneration and demonstrated invasiveness to the surrounding tissue.Lesions were nonuniformly moderate to severe en-hancement.Among 9 patients with MR examination,lesions were mainly unilateral in which 4 cases were in the nasal cavity,3 cases in the paranasal sinuses,2 cases both in the nasal cavity and paranasal sinuses.Lesions were irregular in 9 cases,in which 1 case had typical high signal on T1 WI,low signal on T2 WI,while 3 cases equal signal on T1 WI,equal or slightly higher signal on T2 WI and 5 cases mixed signal.On MR enhanced scan,unevenly slight-medium enhancement were showed in the lesion and surrounding tissues. Conclusion Primary malignant melanoma of the nasal cavity and paranasal sinuses is lack of specificity on CT imaging.Typical ma-lignant melanoma,a type of rare to finding,has certain characteristics on MR,non-pigment type and mixed type are more common. CT combined with MRI can better show the site of the tumor,and the relation with surrounding tissues and adjacent bones.
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With the development of science and technology, the diagnosis and treatment of tumor is more and more advanced, which greatly prolongs patients' survival time and improves the quality of life leading to increased in-cidence and detection rate of multiple primary malignant tumors. However, misdiagnosis of multiple primary malignant tumors increases the mortality rate of patients. In this review, we mainly discussed the overview, epidemiology, etiology, diagnosis, treatment and prognosis of multiple primary malignant tumors.
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Primary malignant melanoma (MM) accounts for 1% of all cancers, and only 3% to 7% of these tumors occur in the female genital tract. Data are limited with respect to the basis for treatment recommendations because of the rarity of MM. The overall prognosis of melanomas of the female genital tract is very poor. Two cases of MM of the female genital tract are presented. The first case is of a 70-year-old female patient who complained of left thigh pain and underwent magnetic resonance imaging that showed cervical cancer with involvement of the vagina, bladder, and parametrium, in addition to multiple bony metastases of the proximal femur, acetabulum, and both iliac bones. The second case is of a 35-year-old female patient who suffered from vaginal bleeding for 5 months, and she was diagnosed as having primary vaginal melanoma. The patient underwent radical surgery and two additional surgeries because of recurrence of cancer in both inguinal areas. After surgery, the patient received adjuvant immunotherapy, radiation therapy, and chemotherapy. In both the aforementioned cases, the pathologic diagnosis was made after immunohistochemical analysis, i.e., the tumor cells were stained with HMB-45 and S100, and were found to be positive for both immunostains.
Subject(s)
Adult , Aged , Female , Humans , Acetabulum , Cervix Uteri , Diagnosis , Drug Therapy , Femur , Immunotherapy , Magnetic Resonance Imaging , Melanoma , Neoplasm Metastasis , Prognosis , Recurrence , Thigh , Urinary Bladder , Uterine Cervical Neoplasms , Uterine Hemorrhage , VaginaABSTRACT
Primary malignant melanoma (MM) accounts for 1% of all cancers, and only 3% to 7% of these tumors occur in the female genital tract. Data are limited with respect to the basis for treatment recommendations because of the rarity of MM. The overall prognosis of melanomas of the female genital tract is very poor. Two cases of MM of the female genital tract are presented. The first case is of a 70-year-old female patient who complained of left thigh pain and underwent magnetic resonance imaging that showed cervical cancer with involvement of the vagina, bladder, and parametrium, in addition to multiple bony metastases of the proximal femur, acetabulum, and both iliac bones. The second case is of a 35-year-old female patient who suffered from vaginal bleeding for 5 months, and she was diagnosed as having primary vaginal melanoma. The patient underwent radical surgery and two additional surgeries because of recurrence of cancer in both inguinal areas. After surgery, the patient received adjuvant immunotherapy, radiation therapy, and chemotherapy. In both the aforementioned cases, the pathologic diagnosis was made after immunohistochemical analysis, i.e., the tumor cells were stained with HMB-45 and S100, and were found to be positive for both immunostains.
Subject(s)
Adult , Aged , Female , Humans , Acetabulum , Cervix Uteri , Diagnosis , Drug Therapy , Femur , Immunotherapy , Magnetic Resonance Imaging , Melanoma , Neoplasm Metastasis , Prognosis , Recurrence , Thigh , Urinary Bladder , Uterine Cervical Neoplasms , Uterine Hemorrhage , VaginaABSTRACT
BACKGROUND: Differentiated thyroid cancer is a common endocrine malignancy with an indolent course and high overall survival rate. With more cases diagnosed early, survivors of this cancer live longer and hence are at risk of second primary cancers. In patients with known primary malignancy, work-up often focuses on the primary disease, so that coexistence of another primary malignant lesion can be missed.CASE PRESENTATION: We report a case of a 78 year-old Filipino male diagnosed to have papillary thyroid cancer with nodal metastases presenting with an incidental rectosigmoid cancer on pre-operative workup.TREATMENT AND OUTCOME: Patient eventually underwent complete surgical removal of both malignancies. He is currently on levothyroxine suppression therapy with no evidence of tumor recurrence for both malignancy and is on close follow-up for cancer recurrence surveillance.CONCLUSION: Clinical vigilance for cancer screening and surveillance is mandatory for patients diagnosed with any type of primary malignancy to reduce the rate of missing secondary primary malignancy simultaneously present in the same patient , Early cancer detection might improve cancer patient's overall prognosis and eventually proved to be life-saving.
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Humans , Male , Aged , Neoplasms , Patients , Prognosis , ThyroxineABSTRACT
We report a case of primary gastric malignant melanoma that was diagnosed after curative resection but initially misdiagnosed as adenocarcinoma. A 68-year-old woman was referred to our department for surgery for gastric adenocarcinoma presenting as a polypoid lesion with central ulceration located in the upper body of the stomach. The preoperative diagnosis was confirmed by endoscopic biopsy. We performed laparoscopic total gastrectomy, and the final pathologic evaluation led to the diagnosis of primary gastric malignant melanoma without a primary lesion detected in the body. To the best of our knowledge, primary gastric malignant melanoma is extremely rare, and this is the first case reported in our country. According to the literature, it has aggressive biologic activity compared with adenocarcinoma, and curative resection is the only promising treatment strategy. In our case, the patient received an early diagnosis and underwent curative gastrectomy with radical lymphadenectomy, and no recurrence was noted for about two years.