Research Progress on Pathogenic Factors of Breast Cancer Combined with Thyroid Cancer / 肿瘤防治研究

Thyroid cancer and breast cancer are two of the most common malignant tumors in women. Concurrent tumors of the thyroid and breast are relatively rare in clinical practice; however, the incidence of such dual malignancies has recently increased. Researches conducted in the past mainly focused on the possible increase in the incidence of contralateral breast cancer, while the increased risk of synchronized thyroid cancer in women with breast cancer has attracted widespread attention recently. The specific mechanism has not been fully understood. This article reviews the pathogenic factors between these two diseases, and evaluates the etiological role of these factors in these double primary cancers, so as to provide a better basis for clinical practice.

Clinical Research Progress of Double Primary Cancers of Breast and Lung with Breast Cancer as the First Primary Cancer / 肿瘤防治研究

The number of the patients with double primary cancers is increasing. Breast cancer and lung cancer are the two most common malignant tumors in women, seriously threatening the health of the majority of women. Although the lung is one of the most common metastatic sites of breast cancer, in recent years, there have been increasing cases of primary lung cancer in patients with breast cancer. The incidence of double primary cancers with breast cancer as the first primary cancer is much higher than that with lung cancer as the first primary cancer. Primary breast cancer is closely related to the occurrence and development of lung cancer. This article reviews the epidemiology, clinicopathological features, diagnosis and treatment of double primary breast cancer and lung cancer with breast cancer as the first cancer.

Synchronous double primary malignant tumours of the tongue and lung: a case report and literature review / 口腔疾病防治

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.

Synchronous papillary thyroid carcinoma with metastatic nasopharyngeal carcinoma issues regarding its diagnosis and management

@#A 46-year old female presented with a one-year history of a right lateral neck mass which gradually increased in size and subsequently involved bilateral cervical nodes. Diagnosed as Papillary Thyroid Carcinoma Stage I (T1N2M0), she underwent Total Thyroidectomy, Central Neck Dissection, Modified Radical Neck Dissection, Type I, right and Modified Radical Neck Dissection Type III, left. Histopathology revealed papillary thyroid carcinoma with no lymphovascular and capsular invasion, and metastatic undifferentiated carcinoma in 15 out of 16 lymph nodes, probably nasopharyngeal in origin. Work up uncovered an erythematous, friable nasopharyngeal mass. Its histopathology was nasopharyngeal cancer, a second primary malignancy. The malignancies were treated as separate entities. The patient underwent chemoradiotherapy first for the nasopharyngeal cancer. Radioactive Iodine for the thyroid malignancy was given six months after completion of radiotherapy. Double primary malignancies deserve aggressive treatment. The sequence of therapy should be based on the severity of the malignancy.

Double malignancies: a clinicopathological and outcomes retrospective analysis from a tertiary cancer referral centre in South India

Background: The presence of second synchronous or metachronous primary malignancies in a cancer patient is not a rare phenomenon. Our study is an endeavour to present data on the frequency, types, and outcomes of double primary malignancies in Indian cancer patients.Methods: This was a retrospective study conducted in 28 cancer patients diagnosed with histologically confirmed double malignancy. Retrospective data of the cancer site, patient’s age at the presentation, gender, type of cancer (synchronous/metachronous), treatment, and outcome were recorded from patients presented with double malignancies from January 2012 to January 2019.Results: Among 28 patients (18 females; 10 males) with multiple primary malignancies, 10 (35.7%) and 18 patients (64.3%), respectively, had synchronous and metachronous primary malignancies. Overall, breast, gynecological, head, and neck cancer were the most common primary malignancies. Gastrointestinal tract, breast, and lung cancer emerged to be the most common second primary malignancy sites. Squamous cell carcinoma (SCC) and invasive ductal carcinoma (IDC) were the most common histopathological types of double malignancies. The majority of the patients received appropriate treatment for both the malignancies.Conclusions: Data from the present study clearly suggest that the occurrence of second primary malignancy is not rare in Indian cancer patients. The double malignancies can occur at any stage and for any type of cancer. Hence, we wish to highlight that the clinician should always be aware of the possibility of developing second malignancy either during evaluation or in follow up of a patient with malignancy.

Synchronous primary cancers: Renal cell carcinoma and rectal cancer

Although cancers of rectum and kidney are common malignancies, the occurrence of primary synchronous neoplasms of these organs has been reported rarely. Very few case reports are available in literature till date. The relationship between these two events remains unclear, probably because of the rarity of the association. In this report, we describe incidentally detected renal cell carcinoma in an elderly man, during staging workup of rectal adenocarcinoma and both malignancies were surgically managed simultaneously with curative intent.

Clinical and pathological features of 50 cases of double primary cancer in the stomach and colorectum / 中国肿瘤临床

Objective: To discuss the clinical and pathological features of double primary cancer (DPC) in the stomach and colorectum. Methods: The data of 50 patients who were diagnosed with DPC and underwent surgery at The Affiliated Tumor Hospital of Xinjiang Medical University between June 2015 and June 2018 were retrospectively analyzed. The data that were analyzed included the age of onset, gender ratio, tumor stage, pathological type, and other characteristics. Thirty patients had synchronous DPC (SC), and 20 had metachronous DPC (MC). Statistical analysis was performed in the two groups. Results: The mean age was (65.44±11.94) years with 37 men and 13 women. The ratio of men to women was 2.85:1. The tumor-node-metastasis (TNM) stages were mainly stagesⅡ-Ⅲ(47/50, 94.0%). The pathological pattern was mainly adenocarcinoma (35/50, 70.0%). There was no significant difference in the pathological type, differentiation degree, and tumor stage between the first and second primary cancers in patients with MC (P<0.05). The age of patients diagnosed with SC was older than that of patients diagnosed with MC [(68.87±8.83) years vs. (60.30±14.22) years] (P=0.011). SC and MC showed no differences in gender, TNM stage, pathological type, differentiation degree, and smoking and alcohol consumption status. Conclusions: Screening for second primary cancer should be strengthened over the age of 50 years for patients with gastric cancer or colorectal cancer.

Synchronous surgical resection of double primary hepatocellular carcinoma and renal cell carcinoma

@#This paper presents a case of a 53 year old, Filipino male, known to have Chronic Hepatitis B infection, presenting with bloatedness and unintentional weight loss attributed to a 21.3cm x 18.2cm x 16.6cm right liver mass with radiographic features pathognomonic for Hepatocellular Carcinoma. An incidental finding of a right renal mass measuring 3.5cm x 3.2cm x 3.4cm is seen in the inferoposterior pole was noted. Multidisciplinary team collectively decided to proceed with outright surgical resection of both hepatic and renal masses over preoperative biopsies of the masses. Histopathologic report of the Right Hemihepatectomy and Right Partial Nephrectomy confirmed the occurrence of a Double Primary Malignancy of Hepatocellular Carcinoma Stage IB and Renal Cell Carcinoma Stage I. The postoperative course is unremarkable, and given a locoregional disease, the patient will undergo active surveillance for tumor recurrence. To the best of the authors’ knowledge, this is the first case of double primary malignancy of the liver and kidney to be diagnosed and simultaneously resected in the Philippines.Improved prognosis of cancer patients and diagnostic modalities contributed to increasing number of reported cases with multiple primary malignancy. In the absence of a set standard of care, multidisciplinary approach has become of greater value in balancing the risks and benefits of selected timely interventions to the patients.

Intra-tumoral Metastatic Double Primary Carcinoma: Synchronous Metastatic Tumor in Lung from Breast and Thyroid Carcinoma / Journal of the Korean Cancer Association, 대한암학회지

Cases of phenotypic heterogeneity of cells within tumors have recently been reported. Here, we report on a patient with characteristic intra-tumor double primary metastases in the lung. This patient was a 40-year-old Korean woman who had been diagnosed with breast cancer (T1N0M0, estrogen receptor/progesterone receptor/HER2 +/+/+) and papillary thyroid cancer three years prior and underwent a complete surgical resection followed by appropriate adjuvant treatment with radiation, hormone, and radioactive iodine. She was recently admitted for newly developed pulmonary nodules. Metastasectomy through video-assisted thoracoscopic surgery revealed recurrent double primary cancer with two different components (metastatic ductal carcinomas from the breast and metastatic papillary carcinomas from the thyroid gland) in each pulmonary nodule in the right upper lobe and right middle lobe. To the best of our knowledge, this is the first report of simultaneous recurrent double metastasis in one organ from different primary origins.

Clinical analysis of 41 cases with resected multiple primary lung cancers / 中国癌症杂志

Background and purpose:Multiple primary lung cancers (MPLC) is a rare entity, but recently there has been a gradual increase in the number of patients diagnosed with MPLC. The aim of this study is to investigate the diagnosis, treatment and prognosis of MPLC through analyzing the clinical data.Methods:Forty-one patients were diagnosed MPLC by Martini-Melamed criteria. Their clinicopathological data were retrospectively reviewed. Results:There were 3 patients with triple primary lung cancer and 38 patients with double primary lung cancer. There were 13 patients with synchronous MPLC, 26 patients with metachronous MPLC, 2 patients with synchronous and metachronous MPLC. Of 85 lesions, the surgical procedures were mainly lobectomy (78.8%, 67/85). Lesions (41.2%, 35/85) were frequently in right upper lobe. Pathological type was mainly adenocarcinoma (70.6%, 60/85),followed by squamous cell carcinoma (17.6%, 15/85). Of 60 adenocarcinoma specimens, the papillary predominant subtype was more common (50%, 30/60). Eighty percent (68/85) of the lesions were stage I. As to the initial cancer and repeated cancer, patients who shared the same pathological type (68.3%, 28/41) were more than the different (31.7%, 13/41), of which adenocarcinoma-adenocarcinoma was most common(82.1%, 23/28). Lesions located in contralateral lobes were in 37 patients (90.2%), and located in ipsilateral different lobes were in 4 patients (9.8%). The 2-year overall survival (OS) of them was 87.8%. Survival analysis showed that the prognosis of patients with same pathological type was better than patients with different pathological type (P=0.037), the prognosis of patients with no lymph node metastasis was better than patients with N1,N2 metastasis (P=0.02).Conclusion:Lesions in patients with multiple primary lung cancers are more frequently in the right upper lobes. The pathology type is mainly adenocarcinoma, of which the papillary predominant subtype was most common. Early diagnosis improves continuously, active treatment with operation can achieve better prognosis.

The expression of CDH1 gene methylation in patients with esophagus and stomach double primary carcinoma and its significance / 中华消化杂志

Objective To study the changes of CDH1 gene promoter CpG island methylation and its clinical significance in patients with esophagus and stomach double primary carcinoma(ESDC).Methods The expression of CDH1 gene methylation in cancerous tissues and adjacent cancerous tissues in 18 cases of ESDC were detected using methylation-specific PCR method. Results Eighteen patients were endoscopically diagnosed as ESDC between Jan. 2007 and Sep. 2009 in the 4th Hospital Affiliated to Hebei Medical University. The positive methylation of CDH1 gene in tissues of esophageal squamous cell carcinoma (ESCC)and adjacent cancer were 66.7% and 33. 3%, respectively, with significant difference (χ2= 4. 167, P = 0. 031). Whereas the positive methylation of CDH1 gene in tissues of gastric carcinoma (GA) and adjacent cancer were 77.8% and 44.4%, respectively, without statistical difference (χ2=1.786, P= 0. 180). There was no significant difference (P=0. 500) in positive rate of CDH1 gene methylation between ESCC tissues and GA tissues in same individual with ESDC. For 18 patients with ESDC, consistent change of CDH1 methylation in tissues of two kinds of cancers was found in 16 patients with a total agreement of 88.9 % (positive agreement of 66.7 % and negative agreement of 22. 2%). Statistical analysis showed a significant correlation between two groups (P = 0. 005). Conclusion In patients with ESDC, there is a high consistency of CDH1 methylation change, between ESCC and GA,which suggests that two kinds of cancer may have similar risk factors and molecular mechanisms.

Double Primary Cancer of the Gallbladder and Cystic Duct: A Case Report

Primary carcinoma of the gallbladder is an uncommon and aggressive malignancy. Furthermore, double primary cancer of the gallbladder and cystic duct is extremely rare and few such cases have been reported. So, we report here on the case of double primary cancer of the gallbladder and cystic duct, which was pathologically confirmed after an operation, and we discuss the US, CT and ERCP findings.

The Synchronous Occurrence of Splenic Marginal Zone Lymphoma in a Patient with Early Gastric Cancer: A Case Report

Splenic marginal zone lymphoma (SMZL) is a rare type of non-Hodgkin's lymphoma (NHL). We report here on a patient who displayed the synchronous occurrence of SMZL and early gastric cancer (EGC). The patient was a 74 year-old male with liver cirrhosis. An EGC in the gastric antrum was diagnosed and the preoperative abdomen computed tomography scan revealed splenomegaly and intra-abdominal lymphadenopathy. We performed subtotal gastrectomy and the postoperative pathologic examination revealed adenocarcinoma limited to the gastric mucosa and SMZL in the lymph nodes. The patient recovered from the surgery without complications and is now awaiting chemotherapy. SMZL has an indolent clinical course with good long-term survival and so there is the possibility of the occurrence of a second primary malignancy. Rare cases of a second primary malignancy being diagnosed along with SMZL have been described in the literature. Patients with SMZL should be carefully followed after treatment to detect the possible occurance of a second primary malignancy.

A Case of Double Primary Cancer in the Esophagus / 대한소화기내시경학회지

Double primary cancer is usually accompanied by gastrointestinal cancer. The incidence of histologically different cancers in the same organ is less than that of double cancers arising from different organs. The cancers accompanied by esophageal squamous cell carcinoma are laryngopharyngeal cancer, gastric adenocarcinoma and primary hepatocarcinoma. Esophageal cancer is supposed to be frequently accompanied by squamous cell carcinoma of the head and neck or the upper respiratory tract because of such common carcinogens as smoking and alcohol ingestion. On the other hand, it is vary rare that a synchronous double primary cancer is diagnosed at the esophagus. We present here a case of double esophageal cancer in a 77 year-old patient who visited our hospital because of progressive dysphagia that she'd experienced for 3 weeks.

Three Cases of Double Primary Cancer in the Esophagus and Stomach / 대한소화기내시경학회지

Double primary cancer means that more than 2 cancers occur independently in an individual. There have been many reports on double primary cancer since Billroth reported it for the first time in 1889 and Warren and Gates established it. The incidence of esophageal cancer is low, about 1~2% of all cancer and, 7% of all gastrointestinal cancer, but double cancer with including esophageal cancer is 9.5~27% of all double primary cancer. Double primary cancer of the esophagus and stomach has occasionally been reported. We have experienced three cases of double primary cancer of squamous carcinoma in the esophagus and adenocarcinoma in the stomach. In this study we reviewed the clinical characteristics of the reported cases of double primary esophageal and gastric cancer that have been reported in Korea and these three cases we experienced at our hospital.

Synchronous Carcinoma Showing Thymus-like Elements (CASTLE) of the Thyroid Combined with Rectal Carcinoma: Report of a Case and Review of the Literature / 대한내분비외과학회지

Carcinoma showing thymus-like elements (CASTLE) is a rare neoplasm arising from the thyroid gland. This tumor is thought to originate from ectopic thymic tissue or remnants related to thymic development in or adjacent to the thyroid gland and usually located in the lower two-thirds of the thyroid gland. The patient was a 66-year-old man admitted to our hospital with rectal carcinoma for surgery. He had undergone a right upper lobectomy of the lung for the pulmonary tuberculosis 35 years previously. He underwent a chest computed tomography (CT) pre-operatively, and an incidental nodule of the thyroid gland was detected. Based on aspiration cytology of the nodule, the lesion was suspected to be an anaplastic carcinoma. He underwent a low anterior resection and thyroid lobectomy for a double primary neoplasm. On the final pathologic examination, the thyroid lesion was shown to be CASTLE. Therefore, completion thyroidectomy with lymph node dissection of the central compartment and radiotherapy were performed, and there was no evidence of recurrence 15 months postoperatively.

Synchronous Double Primary Cancer of the Stomach and Duodenum

The concern about multiple primary cancers has been raised in recent years, but their cause has yet to be elucidated clearly. It has been speculated that many factors may contribute, such as family history, genetic factors, chemotherapy, and radiotherapy.(1) The incidence of multiple primary cancers is estimated to be 13%. However, synchronous multiple primary cancers of the stomach and duodenum are uncommon due to the rarity of duodenal cancer. Duodenal cancer poses diagnostic difficulties because of its rarity, non- specific signs and symptoms, and the fact that duodenum is usually ignored during upper gastrointestinal endoscopy. This 71-year-old female patient was diagnosed with double primary cancer of the stomach and duodenum, which was found by abdominal computed tomography preoperatively, and she underwent a Whipple procedure. The histological diagnosis revealed poorly-differentiated adenocarcinoma in the stomach and moderately-differentiated adenocarcinoma in the duodenum. Here we report a case of synchronous double primary cancer of the stomach and duodenum with a review of the literature.

Synchronous Double Primary Cancers of Lung and Liver / 결핵및호흡기질환

Although reports of multiple primary malignant tumors have increased recently, cases of synchronous double primary tumors of lung and liver are rare. A 73-year-old man suffered from chronic cough. His chest x-ray showed segmental atelectasis of the right upper lobe. Bronchoscopy revealed a mass occluding the orifice of the anterior segmental bronchus of the right upper lobe, and a biopsy showed a squamous cell carcinoma. A synchronous hepatic mass was found by ultrasonography. However, F18-FDG-PET showed no evidence of a distant metastasis. The liver biopsy revealed a hepatocellular carcinoma. A right upper lobe lobectomy and a sleeve resection were performed for the lung cancer, and radiofrequency ablation was performed for the hepatocellular carcinoma.

A Case of Double Primary Cancer that Occurred Continuously at the Esophagogastric Junction / 대한소화기내시경학회지

The occurrence of multiple primary cancers associated with the esophagus and stomach is a well known phenomenon. However, the majority of those lesions are located apart each other. Finding of esophageal cancer and gastric cancer occurring simultaneously at the esophagogastric junction is extremely rare. In this case, the endoscopic findings showed that the cancer of the gastric cardia had invaded to the lower esophagus, but after the operation, the pathology report show the synchronous occurrence of esophageal squamous cell carcinoma and gastric adenocarcinoma. Therefore, we report here on a rare case of double primary cancer, and this double primary cancer occurred at the esophagogastric junction of a 67 year-old woman.

Double Primary Cancer of the Gallbladder and the Ampulla of Vater in Association with Adenoma-Carcinoma Sequence

An adenoma is a rare benign tumor arising in the extra-hepatic biliary duct. Adenocarcinomatous changes are often observed in the background of an adenoma. Double or triple cancer with an adenoma and adenocarcinoma in the biliary tract can be the crucial evidence of the adenoma-carcinoma sequence. We first performed laparoscopic surgery on a 63-year old male patient complaining of pain in the right upper quadrant of the abdomen and jaundice a week earlier, which was initially diagnosed by a radiologist as a sessile polyp of the gallbladder along with stones in the gallbladder and the common bile duct. A mass was found in the distal common bile duct and ampullary area during intraoperative choledochoscopy. The frozen sections taken during surgery indicated a cancer or dysplasia in the gallbladder and the distal common bile duct. The patient underwent a pylorus-preserving pancrea-toduodenectomy. The final diagnosis was a double primary can-cer originating in the gallbladder and the ampulla of Vater with an adnocarcinoma in an adenoma. We report this case with review of the relevant literature.