Secondary primary tumor mimicking osteoradionecrosis

ABSTRACT Nasopharyngeal carcinoma (NPC) is a malignant tumor rarely found in the head and neck, representing about 1% of all malignancies. The main treatment for NPC is radiation therapy, which is often given in combination with chemotherapy. However, such treatment may lead to long‐term complications, including second primary tumors (SPTs) and osteoradionecrosis (ORN). Both complications have similar radiological characteristics, which can lead to erroneous diagnoses. This paper describes a case of a second primary tumor in a patient after 20 years of radiotherapy in the area where a previous extraction was performed, mimicking an osteoradionecrosis process.

Double synchronous primary gastric and thyroid cancer

Second or multiple primary malignancies is very rare and the number of patients diagnosed with multiple primary cancers has recently been increasing due to the improved diagnostic techniques. Herein we report a very rare case of synchronous double primary cancer of the stomach and thyroid gland for the 39 years old lady who presented with a short period of abdominal pain were diagnosed to have an invasive adenocarcinoma with signet ring differentiation of the stomach by gastroscopy and biopsy. Computed tomography and positron emission tomography scan showed high fludeoxyglucose uptake of the thyroid gland were biopsied to confirm the malignancy. underwent initially for radical distal gastrectomy followed by adjuvant chemotherapy and interval total thyroidectomy. Although Synchronous tumors are defined as ≥2 primary tumors occurring within 6 months of diagnosis of the first primary tumor, our case was discovered concomitantly at the first presentation of the patient. The prognosis of patients with multiple primary cancers can be determined independently by the stage of each cancer.

Screening for Lung Cancer Using Low-dose Chest Computed Tomography in Korean Long-term Colorectal Cancer Survivors

BACKGROUND: The National Lung Screening Trial (NLST) and NELSON trial showed that low-dose chest computed tomography (LDCT) screening significantly reduced the mortality form lung cancer. Although cancer survivors are known to have high risk for second malignant neoplasm (SMN), the usefulness of LDCT screening for lung cancer in cancer survivors is not clear. METHODS: Between August 2016 and August 2017, 633 long-term colorectal cancer (CRC) survivors visited the survivorship clinic in Cancer Prevention Center, Yonsei Cancer Center, Seoul, Republic of Korea. We surveyed the smoking status and recommended LDCT screening to ever-smoking CRC survivors aged 55–80 years. The participants were classified into three risk groups: risk group 1 (RG1) who met the NLST criteria (Age 55–74 years, ≥ 30 pack-years of smoking, smoking cessation < 15 years); risk group 2 (RG2) who would not meet the NLST criteria but were at increased 6-year risk of lung cancer (PLCOM2012 ≥ 0.0151); risk group 3 (RG3) who did not meet any of the criteria above. RESULTS: Among 176 ever-smoking CRC survivors, 173 (98.3%) were male, 32 (18.2%) were current-smoker, and median age was 66 years (range, 55–79 years). We found 38 positive findings (non-calcified nodule ≥ 4 mm), 8 clinically significant findings, 66 minor abnormalities, and 64 negative findings on LDCT. Positive findings were identified in 15 of 79 (19.0%) of RG1, in 9 of 36 (25%) of RG2, and in 14 of 61 (23.0%) of RG3. Second primary lung cancers were found in 2 patients of RG2, and in 1 patient of RG3. SMN was most frequently found in RG2 (11 of 36 patients, 30.6%), compared with RG1 (12.7%) or RG3 (9.8%) (P = 0.016). CONCLUSIONS: LDCT screening for lung cancer in Korean CRC survivors is feasible. Well-designed clinical trial for defining high risk patients for lung cancer among CRC survivors is needed.

The Association between Cancer Screening and Cancer History among Korean Adults: The 2010–2012 Korea National Health and Nutrition Examination Survey / 가정의학회지

BACKGROUND: Cancer survivors are at a higher risk of primary cancer recurrence and development of second primary cancer. In both cases, early disease detection is crucial. This cross-sectional study assessed cancer screening participation rates according to cancer history. METHODS: Data were obtained from the 2010–2012 Korea National Health and Nutrition Examination Survey for 12,500 participants. Of these, 624 cancer survivors were enrolled in this study. Sampling weights were applied to maintain the representativeness of the Korean adult population. RESULTS: Overall 2-year cancer screening rates prior to the survey in male and female cancer survivors were 59.9% and 73.7%, respectively, while opportunistic cancer screening rates were 33.5% and 52.1%, respectively. The odds ratios (95% confidence interval) of the overall cancer screening among the cancer survivors, compared to others, were 1.16 (0.79–1.72) in male and 1.78 (1.20–2.63) in female participants, after the adjustment for confounding variables. The odds ratios (95% confidence interval) for opportunistic cancer screening and National Cancer Screening Program among cancer survivors were 1.56 (1.07–2.27) and 0.80 (0.53–1.21) in males and 2.05 (1.46–2.88) and 0.66 (0.46–0.95) in females. CONCLUSION: Female cancer survivors showed a higher rate of overall and opportunistic cancer screening than did the male cancer survivors. Further efforts are required to improve cancer screening among male cancer survivors.

Second Primary Cancer Risk among Kidney Cancer Patients in Korea: A Population-Based Cohort Study / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: Secondary primary cancers (SPCs) commonly arise in patients with renal cell carcinoma (RCC). We designed the present study to estimate the SPC incidence in Korean patients with RCC. MATERIALS AND METHODS: The study cohort was population-based and consisted of 40,347 individuals from the Korean Central Cancer Registry who were diagnosed with primary renal cancer between 1993 and 2013. Standardized incidence ratios (SIRs) for SPCs were estimated for different ages at diagnosis, latencies, diagnostic periods, and treatments. RESULTS: For patients with primary RCC, the risk of developing a SPC was higher than the risk of developing cancer in the general population (SIR, 1.13; 95% confidence interval, 1.08 to 1.18). Most cancer types showed higher incidences in patients with RCC than in the general population. However, the relative incidence of gastric cancer as an SPC varied by age. Gastric cancer incidence was elevated in young patients (< 30 years) with RCC, but reduced in older (≥ 30) patients with RCC. Patients with advanced RCC died prematurely, regardless of SPC development. In contrast, those with early-stage RCC survived for longer periods, although SPC development affected their post-RCC survival. After SPC development, women had better survival than men. CONCLUSION: In Korean patients with primary RCC, the incidence of SPC was 13% higher than the incidence of cancer in the general population. These findings may play important roles in the conduct of follow-up evaluations and education for patients with RCC.

Prognosis of Pancreatic Cancer Patients with Synchronous or Metachronous Malignancies from Other Organs Is Better than Those with Pancreatic Cancer Only / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: Pancreatic cancer associated double primary tumors are rare and their clinicopathologic characteristics are not well elucidated. MATERIALS AND METHODS: Clinicopathologic factors of 1,352 primary pancreatic cancers with or without associated double primary tumors were evaluated. RESULTS: Of resected primary pancreatic cancers, 113 (8.4%) had associated double primary tumors, including 26 stomach, 25 colorectal, 18 lung, and 13 thyroid cancers. The median interval between the diagnoses of pancreatic cancer and associated double primary tumors was 0.5 months. Overall survival (OS) of pancreatic cancer patients with associated double primary tumors was longer than those with pancreatic cancer only (median, 23.1 months vs. 17.0 months; p=0.002). Patients whose pancreatic cancers were resected before the diagnosis of metachronous tumors had a better OS than patients whose pancreatic cancer resected after the diagnosis of metachronous tumors (48.9 months and 13.5 months, p=0.001) or those whose pancreatic cancers were resected synchronously with non-pancreas tumors (19.1 months, p=0.043). The OS of pancreatic cancer patients with stomach (33.9 months, p=0.032) and thyroid (117.8 months, p=0.049) cancers was significantly better than those with pancreas cancer only (17.0 months). CONCLUSION: About 8% of resected pancreatic cancers had associated double primary tumors, and those from the colorectum, stomach, lung, and thyroid were common. Patients whose pancreatic cancer was resected before the diagnosis of metachronous tumors had better OS than those resected after the diagnosis of metachronous tumors or those resected synchronously.

Risk of Second Primary Cancer in People with Non-melanoma Skin Cancer: A Nationwide Cohort Study / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: Previous western studies have found Caucasians with skin cancer, either melanoma or nonmelanoma skin cancer (NMSC), have an elevated risk of second primary cancer. Our objective was to assess the risk of second primary cancer in Taiwanese with NMSC. MATERIALS AND METHODS: By using data from Taiwan's National Health Insurance Research Database, we conducted a population-based cohort study to assess the risk of incident second primary cancer in Taiwanese affected by NMSC. RESULTS: We identified 505 subjects with NMSC and 2,020 matched controls. After adjustment for potential confounders including age, sex, urbanization, and Charlson Comorbidity Index, people who had NMSC had a 1.43-fold (95% confidence interval [CI], 1.05 to 1.96) risk for the development of second primary cancer as comparedwith control group. Menwith NMSC had a 2.99-fold (95% CI, 1.00 to 9.10) risk for second primary cancer involving the lip, oral cavity, and pharynx and a 3.51-fold (95% CI, 1.21 to 10.17) risk for second primary cancer involving the genitourinary organs when compared to the control group. By contrast, women with NMSC did not have an increased risk of second primary cancer. CONCLUSION: This study revealed Asians with NMSC have an increased risk of second primary cancer. Our findings can be a useful reference for health care for people diagnosed with NMSC.

Comparison of characteristics in patients with both thyroid and breast cancer: Based on order of incidence

PURPOSE: Clinicopathologic characteristics of patients with both thyroid and breast cancer during their lifetime were analyzed to investigate the association between the two malignancies according to the order of incidence.METHODS: A total of 405 patients who underwent surgery for breast and thyroid cancer at Severance Hospital between 1995 and 2014 were retrospectively selected and classified into 3 groups according to the order of incidence of the two cancers: simultaneous cancer (S), thyroid cancer followed by breast cancer (TB), and breast cancer followed by thyroid cancer (BT). Univariate analysis was conducted to compare parameters.RESULTS: S, TB, and BT groups were 166 (41.0%), 96 (23.7%), and 143 (35.3%) patients, respectively. In TB and BT groups, tumor size and surgical site for secondary cancer were smaller; therefore, adjuvant treatments were less frequently required for secondary cancer. ER positive rate was 77.1% in S, 75% in TB, and 63.7% in BT groups (P=0.027). The ratio of ER negative was higher in the group with BRAF mutation. Survival rate for index tumor was higher in order from TB, and BT, followed by S groups without statistical difference.CONCLUSION: It is difficult to find a significant difference according to the order of occurrence except by screening test, and more studies are needed in the future. Establishing an appropriate screening program is important in order to detect secondary breast or thyroid cancer after surgery for thyroid or breast cancer.

Metástasis hepáticas en el cáncer colorrectal: estrategias terapéuticas y recomendaciones actuales / Hepatic metástases in colorectal cancer: therapeutic strategies and current recommendations

El cáncer colorrectal con metástasis a hígado es una enfermedad frecuente que hasta hace pocos años se consideraba únicamente de tratamiento paliativo. Sin embargo, con la reciente aparición de nuevas técnicas y avances para aumentar la posibilidad de resecar las lesiones y los nuevos esquemas de quimioterapia, se ha logrado la resección quirúrgica de este tipo de lesiones, extrayendo todo el tejido tumoral macroscópico e impactando de forma positiva la supervivencia de estos pacientes. Múltiples esquemas se han propuesto para el tratamiento de las lesiones sincrónicas con el fin de mejorar la supervivencia de los pacientes. Si bien no hay consenso sobre cuál es el mejor esquema terapéutico en estos casos, parece ser que lo más importante es que se logre completar de manera exitosa el esquema elegido. En general, la tendencia actual es practicar las intervenciones quirúrgicas del hígado primero, a menos que el tumor primario se encuentre sintomático; en este caso, la colectomía es el abordaje inicial. Las resecciones simultáneas hacen parte del arsenal terapéutico de estos pacientes. Múltiples grupos sugieren no asociar una resección de recto bajo a una hepatectomía mayor. Por su parte, las lesiones metacrónicas deben resecarse según el tamaño y la posibilidad de resección una vez hecho el diagnóstico. Es importante tener en cuenta que, aunque se logre una resección completa del tejido tumoral con márgenes R0 , las recurrencias son frecuentes debido a que la diseminación tumoral microscópica ya está presente; por esta razón, es indispensable agregar la quimioterapia para mejorar el pronóstico de los pacientes

Metastatic colorectal cancer in the liver is a frequent pathology that until a few years ago was considered only for palliative management. However, with the recent advent of new techniques and advances to improve the resectability of such lesions and the new schemes of chemotherapy, oncological resection of these lesions can be performed, extracting all macroscopic tumor and achieving a positive impact on patient´s survival. Multiple schemes have been postulated for the management of synchronous lesions in order to improve patient survival, although there is no consensus about which is the best scheme in these cases; it seems that the most important factor is to complete successfully the proposed scheme. In general, the current trend is to perform the liver resection first unless the primary tumor is symptomatic, in which case a colectomy should be performed as the initial approach. Simultaneous resections are part of the therapeutic arsenal in these patients. Many groups suggest not to associate a low rectal resection with a major hepatectomy. On the other hand, metachronic lesions should be resected based on their size and the possibility of resection should be considered once the diagnosis has been made. It is important to take into account that even if a complete resection of the tumor and R0 margins are achieved, recurrences are frequent because microscopic tumor dissemination is already present; therefore, the addition of chemotherapy regimens should be mandatory to Improve the oncological prognosis of these patients

Secondary Primary Prostate Cancer after Colorectal Cancer: A Nationwide Population-based Cohort Study in Korea

BACKGROUND: Colorectal cancer (CRC) and prostate cancer frequently occur in developed countries. There are several reports on the association between CRC and prostate cancer; however, the conclusions are inconsistent to investigate the association of the development of secondary primary prostate cancer among patients with prior primary CRC using a nationwide population-based dataset. METHODS: Patients registered in the Republic of Korea National Health Insurance System database who were diagnosed with CRC between 2007 and 2012 were followed-up until the end of 2015, and we investigated the new diagnosis secondary primary prostate cancer. We compared the incidence of prostate cancer in age-matched controls using the Cox proportional hazards models. RESULTS: We analyzed a total of 85,455 first primary CRC survivors. During the follow-up period of 494,222 person-years, 2,005 patients (2.30%) developed secondary primary prostate cancer (incidence rate 4.06/1,000 person-years). The median duration of follow-up was 5.78 years. Compared with the general population, CRC patients had a significantly increased risk of secondary primary prostate cancer (HR = 2.30, 95% CI = 2.18–2.43; P < 0.001). Multivariate analysis (including age, sex, body mass index, hypertension, diabetes mellitus, dyslipidemia, and income) showed that age < 55 years (HR = 20.74, 95% CI = 11.81–36.41; P < 0.001) is a significant independent predictor of secondary primary prostate cancer development. CONCLUSIONS: Men diagnosed with colorectal cancer are at an increased risk of secondary primary prostate cancer, particularly those aged < 55 years. The data suggests that colorectal cancer patients aged < 55 years require regular screening for prostate cancer.

Risk of Second Primary Malignancy in Breast Cancer Survivors: A Nested Population-Based Case-Control Study / 한국유방암학회지

PURPOSE: Evolving therapies have improved the prognoses of patients with breast cancer; and currently, the number of long-term survivors is continuously increasing. However, these patients are at increased risk of developing a second cancer. Thus, late side effects are becoming an important issue. In this study, we aimed to investigate whether patient and tumor characteristics, and treatment type correlate with secondary tumor risk. METHODS: This case-control study included 305 patients with a diagnosed second malignancy after almost 6 months after the diagnosis of primary breast cancer and 1,525 controls (ratio 1:5 of cases to controls) from a population-based cohort of 6,325 women. The control patients were randomly selected from the cohort and matched to the cases according to age at diagnosis, calendar period of diagnosis, disease stage, and time of follow-up. RESULTS: BRCA1 or BRCA2 mutation, human epidermal growth factor receptor 2 (HER2)+ status, chemotherapy, and radiotherapy were related to increased risk of developing a second cancer, whereas hormonotherapy showed a protective effect. Chemotherapy, radiotherapy, and estrogenic receptor level <10% increased the risk of controlateral breast cancer. HER2+ status increased the risk of digestive system and thyroid tumors, while BRCA1 or BRCA2 mutation increased the risk of cancer in the genital system. CONCLUSION: Breast cancer survivors are exposed to an excess of risk of developing a second primary cancer. The development of excess of malignancies may be related either to patient and tumor characteristics, such as BRCA1 or BRCA2 mutation and HER2+ status, or to treatments factors.

Metachronous Double Primary Cancer after Treatment of Breast Cancer / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: The pattern of double primary cancer after treatment for breast cancer is important for patient survival. MATERIALS AND METHODS: We analyzed 108 cases of metachronous double primary cancer in breast cancer patients treated from 1999 to 2012. RESULTS: Metachronous double primary cancers occurred in 108 of 2,657 patients (4.1%) with breast cancer. The median time to the occurrence of second cancer after diagnosis of the first was 58.4+/-41.2 months (range, 6.9 to 180.2 months). The most common cancer was thyroid cancer, which occurred in 45 patients (41.7%). This was followed by gastric cancer in 16 patients (14.8%), endometrial cancer in 10 patients (9.3%), and cervical cancer in seven patients (6.5%). The relative risk showed a significant increase in endometrial (4.78; 95% confidence interval [CI], 1.66 to 13.79), gastric (2.61; 95% CI, 1.68 to 4.06), and thyroid cancer (1.95; 95% CI, 1.37 to 2.79). At 5 years after diagnosis of breast cancer, secondary cancer occurred in 48 patients (44.4%), with 50.0% of the endometrial, 56.3% of the stomach, and 37.8% of the thyroid cancer cases being diagnosed after 5 years. Median survival after diagnosis of the second cancer was 123.9+/-11.2 months. The prognosis was mainly influenced by the anatomic site. CONCLUSION: The incidence of endometrial, stomach, and thyroid cancer increased significantly after treatment with primary breast cancer, and survival was dependent on early detection and the type of second primary cancer. A prolonged follow-up examination for metachronous double primary cancer is needed to provide early detection and improve survival time in patients with breast cancer.

Oncologists' Experience with Patients with Second Primary Cancer and the Attitudes toward Second Primary Cancer Screening: A Nationwide Survey / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: Screening for second primary cancer (SPC) is one of the key components to survivorship care. We aim to evaluate the oncologists' experience with SPCs and assess the current practice, perceived barriers, and recommendations related to SPC screening. MATERIALS AND METHODS: A nationwide survey was conducted with a representative sample of 496 Korean oncologists. A questionnaire based on the findings from our previous qualitative study was administered. RESULTS: More than three-fourths of oncologists (76.3%), who participated in the study, had experience with SPC patients. Over half of them (51.9%) stated that it was an embarrassing experience. While the current management practice for SPC varies, most oncologists (80.2%) agreed on the necessity in proactively providing information on SPC screening. A short consultation time (52.3%), lack of guidelines and evidence on SPC screening (47.7%), and patients' lack of knowledge about SPCs (45.1%) or SPC screening (41.4%) were most frequently reported as barriers to providing appropriate care for managing SPC. Oncologists recommended the development of specific screening programs or guidelines in accordance to the type of primary cancer (65.9%), the development of an internal system for SPC screening within the hospital (59.7%) or systematic connection with the national cancer screening program (44.3%), and education of oncologists (41.4%) as well as patients (48.9%) regarding SPC screening. CONCLUSION: Many oncologists reported the occurrence of SPC as an embarrassing experience. Given the variations in current practice and the lack of consensus, further studies are warranted to develop the optimal clinical strategy to provide SPC screening for cancer survivors.

The prognosis and treatment of primary thyroid cancer occurred in breast cancer patients: comparison with ordinary thyroid cancer

PURPOSE: Due to the increased prevalence of thyroid cancer, it has been frequently detected in breast cancer patients recently. The aim of this study was to evaluate the clinicopathologic characteristics of thyroid cancer in breast cancer patients with respect to prognosis and treatment. METHODS: From August 1998 to September 2012, 101 breast cancer patients were diagnosed with thyroid cancer (BT group). One hundred ninety-three female patients with a thyroid malignancy that underwent thyroidectomy in 2008 were recruited as controls (oT group). The clinicopathologic results of these two groups were compared. RESULTS: Patients were older (51.40 vs. 47.16, P < 0.001), mean tumor size was smaller (0.96 cm vs. 1.43 cm, P < 0.001), and extrathyroidal extension was less common in the BT group. In both groups, papillary thyroid carcinoma was the most common type of thyroid malignancy. T and N classifications of thyroid cancer were less severe in the BT group, but group TNM stages were similar. Endoscopic thyroid surgery was performed in 12.9% of patients in the BT group and in 6.7% of patients in the oT group. Postoperative radioactive iodine ablation was performed less often in the BT group (P < 0.001). Group recurrence rates were not significantly different. CONCLUSION: Thyroid cancer in breast cancer patients was diagnosed at earlier status than ordinary thyroid cancer. However, the prognosis of thyroid cancer in breast cancer patients was not superior to that in patients with thyroid cancer alone. Radioactive iodine ablation was performed less often and endoscopic surgery could be performed in breast cancer patients.

Metachronous Adenoid Cystic Carcinoma in the Peripheral Lung and at Base of the Tongue

Primary lung adenoid cystic carcinoma (ACC) is extremely rare and accounts for approximately 0.1%-0.2% of all lung cancers. ACC of the head and neck has generally been regarded as a slow-growing, low-grade malignancy which has a tendency for local recurrence and frequent distant metastasis. When ACC of the lung is identified, physicians must determine whether it represents distant metastasis or a primary lung cancer. Thyroid transcription factor-1 staining is one of the most useful methods to differentiate primary from metastatic lesions in lung cancer. Herein we report a case of metachronous, not synchronous, ACC at the peripheral lung followed by ACC presentation at the base of the tongue, and review of relevant literatures.

Locoregional Recurrence of a Tongue Cancer Patient with 10 Year Follow-up

Angiomatoid Fibrous Histiocytoma as a Second Tumor in a Young Adult with Testicular Cancer / Journal of the Korean Cancer Association, 대한암학회지

Angiomatoid fibrous histiocytoma (AFH) is a rare soft tissue tumor, with a low-grade malignant potential, occurring predominantly in children and young adults. Association between AFH and other malignancies has been rarely reported. A 27-year-old man who presented with a palpable abdominal mass was diagnosed as having testicular cancer with multiple liver and lung metastases. At 16 months after chemotherapy, a follow-up computed tomographic scan revealed a supraclavicular mass measuring 3 cm in size, which was suspected to be a recurrence. The patient underwent surgical excision, and the mass was pathologically diagnosed as a AFH. The patient has had no local recurrence and no distant metastasis for 12 months after resection. To the best of our knowledge, this is the first case report of AFH as a second tumor in a patient with testicular cancer.

Metachronous Double Primary Cancer after Diagnosis of Gastric Cancer / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: The pattern of double primary cancers after treatment for gastric cancer is important for a patient's survival. MATERIALS AND METHODS: We analyzed the clinicopathologic data of 214 gastric cancer patients from October 1996 to November 2007 with regard to metachronous second primary cancers. RESULTS: Out of 5,778 patients with gastric cancer, metachronous second primary cancers occurred in 214 patients. The median age was 61.8 years, the number of male and female patients was 140 (65.4%), 74 (34.6%), respectively. The median time to the occurrence of second cancers after diagnosis of the first was 39.2 months (standard deviation, 31.2 months). The most common cancer was colorectal cancer, which occurred in 44 patients (20.6%), and lung cancer in 33 patients (15.4%), hepatocellular carcinoma in 26 patients (12.1%), ovarian cancer in 15 patients (7.0%), cervical cancer in 12 patients (7.0%), breast cancer in 11 patients (5.1%), and esophageal cancer in 11 patients (5.1%). The observed/expected (O/E) ratio showed a significant increase in colorectal (1.25), male biliary (1.60), ovarian (8.72), and cervical cancer (3.33) with primary gastric cancer. After five years from diagnosis of gastric cancer, secondary cancer occurred in 50 patients (23.4%), and breast cancer, prostate cancer, laryngeal cancer, lung cancer, and hepatocellular carcinoma were the most frequent. CONCLUSION: The O/E ratio showed a significant increase in colorectal, male biliary, ovarian, and cervical cancer with primary gastric cancer, and second primary cancer as the main cause of death for these patients. A follow-up examination for metachronous double primary cancer is needed in order to improve the survival time in patients with gastric cancer.

The Clinicopathologic Features of Synchronous and Metachronous Cancer in Patients with Gastric Cancer

PURPOSE: With the development of diagnostic techniques, second primary neoplasms such as synchronous or metachronous cancers in gastric cancer patients are being increasingly found. In this study, we investigated the clinicopathological features and clinical significance of gastric neoplasms combined with synchronous and metachronous cancers. MATERIALS AND METHODS: 1,048 patients who were diagnosed with gastric cancer in Chosun University Hospital from January 1998 to March 2008 were retrospectively reviewed. RESULTS: 38 of the 1,048 patients with gastric cancer (3.6%) had synchronous and metachronous cancers. Of the 38 patients, 16 patients (42.1%) had synchronous cancer and 22 patients (57.9%) had metachronous cancer. The average time interval between gastric cancer and the secondary primary cancer was 27.08+/-31.25 months. The most common second primary neoplasm was lung cancer (8/38, 21.1%), followed by colorectal cancer (8/38, 21.1%). Among the 27 patients who underwent surgical resection for gastric cancer, 5 patients (18.5%) were in the synchronous group and 22 patients (81.5%) were in the metachronous group. The mean survival time of the 38 patients was 49.8 months. The mean survival time was 24.6 months for the synchronous cancer patients and 68.1 month for the metachronous cancer patients. The 3 year survival rate of the synchronous group and the metachronous group was 33.3% and 81.1%, respectively. CONCLUSION: We must pay attention on the preoperative workup for synchronous cancer and on the postoperative follow-up for metachronous cancer in gastric cancer patients.

Metachronous Mantle Cell Lymphoma with Leukemic Presentation in a Patient with Early Gastric Cancer: A Case Report / 대한혈액학회지

We report here on a case of metachronous second primary non-Hodgkin's lymphoma (NHL) that was diagnosed 6 years after performing subtotal gastrectomy for treating early gastric cancer (EGC). The subtype analysis revealed mantle cell lymphoma (MCL) of the blastic variant with a leukemic presentation, which was composed of mixed small and medium-sized cells. The immunohistochemical staining for cyclin-D1 was positive. The cytogenetic study revealed t(4;6). In Korea, the risk of developing a second primary cancer following gastric cancer was reported to be less than 3.4%, and NHL comprised less than 6.3% of this second primary cancer. Furthermore, MCL represents about 2% of all lymphomas in Korea. To the best of our knowledge, this is the first report of metachronous primary MCL with a leukemic presentation following curative resection of EGC.