Cáncer Gástrico Bifocal con Linfonodos Negativos en un Paciente con Cirrosis Hepática / Bifocal Gastric Cancer with Negative Lymph Nodes in a Hepatic Cirrhosis Patient

El cáncer gástrico (CG), es la primera causa de muerte por cáncer, en hombres, y la tercera en mujeres, en Chile. No obstante ello, el CG bifocal (CGB) es una situación poco frecuente. El objetivo de este manuscrito fue reportar un caso de CGB, con linfonodos negativos en un paciente con cirrosis hepática, que fue intervenido quirúrgicamente; y revisar la evidencia existente respecto de sus características morfológicas, terapéuticas y pronósticas. Caso clínico: Hombre de 74 años diabético, hipertenso, insuficiente cardíaco y cirrótico; portador de CGB (subcardial y antro-pilórico), diagnosticado por endoscopia y con confirmación histológica de ambas lesiones; operado en Clínica RedSalud Mayor Temuco en septiembre de 2023. En el intraoperatorio se verificó además la coexistencia de una lesión de aspecto metastásico en el segmento III del hígado, y adhesión de la región antro-pilórica a la vesícula biliar. Se realizó gastrectomía total, linfadenectomía D2, esófago-yeyuno anastomosis término-lateral, resección segmentaria hepática (segmento III) y colecistectomía. El paciente permaneció 6 días en la UCI debido a que desarrolló insuficiencia hepática (encefalopatía leve y ascitis). Se alimentó vía enteral por sonda naso-yeyunal. Posteriormente inició alimentación oral progresiva, la que fue bien tolerada. Completó 11 días de hospitalización en servicio médico-quirúrgico, donde mejoró actividad neurológica, hasta su alta domiciliaria. Actualmente, lleva dos meses desde su operación, se encuentra en buenas condiciones generales, y el Comité Oncológico decidió no dar quimioterapia adyuvante. Se presenta un caso inusual de CG de tipo bifocal, respecto de lo cual hay escasa información disponible. Se logró realizar cirugía con intención curativa en un paciente de alto riesgo, con un resultado exitoso.

SUMMARY: Gastric cancer (GC) is the first cause of death from cancer in men, and the third one in women, in Chile. However, a bifocal GC (BGC) is uncommon. The aim of this study was to report a case of CGB, with negative-lymph nodes in a patient with liver cirrhosis, who underwent surgery; and review the existing evidence regarding its morphological, therapeutic and prognostic characteristics. Clinical case: A 74-year-old male patient with a medical history of diabetes, hypertension, congestive heart failure, and cirrhosis underwent surgical intervention for GC located in subcardial and antro- pyloric regions. The diagnosis was established via endoscopy and confirmed histologically. Surgery was performed at the RedSalud Mayor Temuco Clinic in September 2023. During intraoperative assessment, the coexistence of a lesion with metastatic-like characteristics in segment III of the liver was also verified, along with adhesions between the antro-pyloric region and the gallbladder. Surgical approach encompassed total gastrectomy, D2 lymphadenectomy, esophago-jejunostomy, segmental hepatic resection, and cholecystectomy. Subsequently, the patient required a six-day stay in ICU due to the development of hepatic insufficiency, characterized by mild encephalopathy and ascites. Enteral nutrition was administered via a naso-jejunal tube, followed by a gradual transition to oral feeding, which was well-tolerated. The patient completed an 11-day hospitalization period in the medical-surgical ward, during which his neurological function improved significantly, resulting in his discharge. At present, 2 months post-surgery, the patient remains in satisfactory general health, and the Oncology Committee decided not to proceed with adjuvant chemotherapy. This case represents a rare instance of bifocal GC, for which there is limited available literature. Surgical intervention with curative intent was successfully carried out in a high-risk patient, yielding a positive outcome.

Oncologic Panendoscopy: Description of an Optimized Procedure Based on Our Experience

Abstract Introduction All patients with a new head and neck squamous cell carcinoma (HNSCC) undergo diagnostic panendoscopy as part of the screening for synchronous second primary tumors. It includes a pharyngolaryngoscopy (PLS), a tracheobronchoscopy and esophagoscopy, and a stomatoscopy. Rigid techniques are risky, with long learning curves. Objective We propose a precise description of the panendoscopy protocol. We include an optimization of the PLS technique that completes the flexible esophagoscopy when rigid esophagoscopy isn't performed. Methods The present retrospective observational study includes 122 consecutive patients with a new primary HNSCC who underwent traditional panendoscopy and the new PLS technique between January 2014 and December 2016. A two-step procedure using a Macintosh laryngoscope and a 30° telescope first exposes panoramically the larynx, the upper trachea, and the oropharynx; then, in a second step, the hypopharynx is exposed down to the upper esophageal sphincter. Broncho-esophagoscopy is performed with a rigid and flexible scope. Results In total, 6 (5%) patients presented synchronous tumors (3 in the esophagus, 2 in the oral cavity, and 1 in the larynx 1). Rigid endoscopy was complicated by 2 (1,6%) dental lesions, and had to be completed with a flexible scope in 38 (33%) cases for exposition reasons. The two-step PLS offered a wide-angle view of the larynx, upper trachea, and oroand hypopharynx down to the sphincter of the upper esophagus. The procedure was easy, reliable, safe, repeatable, and effectively completed the flexible endoscopies. Conclusion Rigid esophagoscopy remains a difficult procedure. Two-step PLS combined with flexible broncho-esophagoscopy offers good optical control.

Prognostic factors of synchronous endometrial and ovarian endometrioid carcinoma / 부인종양

OBJECTIVE: Gynecologists occasionally encounter synchronous endometrial and ovarian endometrioid carcinoma (SEO-EC) patients who show favorable prognosis than locally advanced or metastatic disease patients. This study aimed to elucidate prognostic factors of SEO-EC and identify patients who have a sufficiently low risk of recurrence without receiving adjuvant chemotherapy. METHODS: We retrospectively reviewed 46 patients with pathologically confirmed SEO-EC who underwent surgery at the National Cancer Center Hospital between 1997 and 2016. Immunohistochemical evaluation of DNA mismatch repair (MMR) protein expression were performed for both endometrial and ovarian tumors. Patient outcomes were analyzed according to clinicopathologic factors. RESULTS: From the multivariate analysis, cervical stromal invasion indicated a worse prognosis for progression-free survival (hazard ratio [HR]=6.85; 95% confidence interval [CI]=1.50–31.1) and overall survival (HR=6.95; 95% CI=1.15–41.8). Lymph node metastasis and peritoneal dissemination did not significantly affect survival. MMR deficiency was observed in 13 patients (28.3%), with both endometrial and ovarian tumors showing the same MMR expression status. MMR deficiency was not significantly associated with survival. Of 23 patients with lesions confined to only the uterine body and adnexa, only 2 had recurrence in the group receiving adjuvant therapy, while none of the 10 patients who did not receive adjuvant therapy had recurrence. CONCLUSION: SEO-EC patients with tumors localized to the uterine body and adnexa lesions had a low risk for recurrence and may not require adjuvant therapy. SEO-EC may have prognostic factors different from those of endometrial and ovarian cancer.

Tres cánceres primarios simultáneos: reporte de caso y revisión de la literatura / Three simultaneous primary cancers: Case report and literature review

Resumen La presencia de un segundo o tercer cáncer primario después del diagnóstico inicial de malignidad es un evento cada vez más frecuente asociado con la mejor sobrevida y seguimiento de pacientes con cáncer a nivel mundial. Sin embargo, la presencia de tres neoplasias primarias simultáneas sigue siendo un evento singular. Presentamos el caso de una mujer de 76 años con tumor neuroendocrino del intestino delgado, adenocarcinoma de colon sigmoide y adenocarcinoma mucinoso de ovario de manera simultánea, manejada quirúrgicamente. Reali zamos una revisión de la literatura.

Abstract The presence of a second or third primary cancer after the initial diagnosis of malig nancy is an increasingly frequent event associated with the improved survival and monitoring of cancer patients worldwide. However, the presence of three simultaneous primary neoplasms remains a singular event. The case is presented of a 76-year-old woman with a neuroendo crine tumour of the small intestine, sigmoid colon adenocarcinoma, and a mucinous ovarian adenocarcinoma, simultaneously surgically managed. A literature review on the topic was also conducted.

Laser Imaging Facilitates Early Detection of Synchronous Adenocarcinomas in Patients with Barrett's Esophagus

Barrett's adenocarcinoma may occur in multiple sites, and recurrence and metachronous lesions are the major problems with endoscopic resection. Therefore, early detection of such lesions is ideal to achieve complete resection and obtain improved survival rates with minimally invasive treatment. Laser imaging systems allow multiple modalities of endoscopic imaging by using white light laser, flexible spectral imaging color enhancement (FICE), blue laser imaging (BLI), and linked color imaging even at a distant view. However, the usefulness of these modalities has not been sufficiently reported regarding Barrett's adenocarcinoma. Here, we report on a patient with three synchronous lesions followed by one metachronous lesion in a long segment with changes of Barrett's esophagus, all diagnosed with this new laser endoscopic imaging system and enhanced by using FICE and/or BLI with high contrast compared with the surrounding mucosa. Laser endoscopic imaging may facilitate the detection of malignancies in patients with early Barrett's adenocarcinoma.

Combinación poco frecuente de neoplasias múltiples sincrónicas / A rare combination of multiple synchronous neoplasms

Se presenta el caso de una paciente portadora de tres neoplasias sincrónicas diagnosticadas simultáneamente: un tumor de Brenner calcificado del ovario izquierdo, un carcinoma urotelial papilar de alto grado de la vejiga urinaria y un adenocarcinoma moderadamente diferenciado del pulmón derecho. Se practicó el tratamiento quirúrgico exerético de todos los tumores. Se administró un tratamiento de radioterapia más quimioterapia concurrente adyuvante para el tumor urotelial de la vejiga urinaria y otro esquema quimioterápico adyuvante para el adenocarcinoma pulmonar. No se presentaron complicaciones trans ni posoperatorias, ni como consecuencia de los tratamientos adyuvantes. Al momento de la presente publicación la paciente está viva y controlada de su enfermedad(AU)

The case of a patient with three simultaneously diagnosed synchronous neoplasms is presented: a calcified Brenner tumor of the left ovary, an advanced stage papillary urothelial carcinoma in the bladder, and a moderately differentiated adenocarcinoma to the right lung. The excisional surgical treatment of all tumors was performed. She had radiation treatment and concurrent adjuvant chemotherapy for transitional cell carcinoma of the urinary bladder and other adjuvant chemotherapy plan for lung adenocarcinoma. No intraoperative or postoperative complications occurred, or any other derivative effects of adjuvant treatments. At the time of this publication, the patient is alive and her disease is under control(AU)

Synchronous Occurrence of Papillary, Follicular, and Medullary Carcinoma in the Same Thyroid Gland / 대한내분비외과학회지

Incidence of thyroid carcinoma has increased dramatically; however, simultaneous occurrence of different tumors in a single thyroid gland is rare and the embryologic or molecular explanations for such cases lack a solid basis. We report on a 67-year-old woman who underwent surgery for cytologically undetermined nodules in the bilateral thyroid glands. Postoperative pathology findings indicated synchronous occurrence of discrete papillary, follicular, and medullary thyroid carcinoma. She has remained disease-free after postoperative radioactive iodine therapy (130 mCi). This is the fifth report on the synchronous occurrence of different tumors in a single thyroid gland worldwide, and the first ever in Asia.

Synchronous Bilateral Male Breast Cancer: A Case Report / 한국유방암학회지

Synchronous bilateral breast cancer is extremely rare in men and has not, up to date, been reported in Korea. A 54-year-old man presented with a palpable mass in the right breast. The right nipple was retracted and bilateral axillary accessory breasts and nipples were present. On physical examination, a 2 cm-sized mass was palpated directly under the right nipple, and, with squeezing, bloody discharge developed in a single duct of the left nipple. There was no palpable mass in the left breast, and axillary lymph nodes were not palpable. Physical examination of external genitalia revealed a unilateral undescended testis on the left side. Synchronous bilateral breast cancer was diagnosed using mammography, ultrasonography, and core-needle biopsy. Histopathological examination revealed invasive ductal carcinoma in the right breast and ductal carcinoma in situ in the left breast. Bilateral total mastectomy, sentinel lymph node biopsy, and excision of accessory breasts in the axilla were performed.

A Case of Synchronous Double Primary Cancer of Gastric Adenocarcinoma and Diffuse Large B Cell Lymphoma / 대한소화기학회지

The simultaneous occurrence of primary gastric lymphoma and adenocarcinoma is rarely reported. We here report a case of synchronous double primary tumor of advanced gastric cancer and diffuse large B cell lymphoma. A 65-year-old woman underwent an esophagogastroduodenoscopy for the evaluation of abdominal discomfort of two months' duration. The endoscopic examination showed an ulcerating tumor in the gastric antrum and thickened folds in the fundus and the microscopic examination revealed an adenocarcinoma in the antrum and a diffuse large B-cell lymphoma in the fundus. She has had total gastrectomy and CHOP chemotherapy with rituximab. Since the cases of synchronous double primary gastric tumors have been increased on the recent medical advances, when a gastric tumor is detected for the endoscopic examination, an endoscopist has to make every endeavor not to miss another tumor in the stomach.

Renal Cell Carcinoma with Double Synchronous Contralateral Adrenal Metastases

A 63-year-old male patient visited our hospital with a right incidental renal tumor, which was found by ultrasonography for the follow-up study of chronic hepatitis B virus infection and diabetes mellitus. Consecutive computed tomography revealed a right renal tumor and two left adrenal tumors. Further systemic imaging study and hormonal examination suggested one right renal cell carcinoma and left adrenal metastases. We performed right nephrectomy and left adrenalectomy. The pathological diagnoses of all resected tumors were renal cell carcinoma. The patient has been in good health without any recurrence for 12 months since the operation. In patients with renal cell carcinoma, contralateral adrenal metastasis is usually associated with multiple metastases to other organs. There are a few cases of solitary and synchronous contralateral adrenal metastasis in the English literature. To our knowledge, this is the first report of a case of renal cell carcinoma with double synchronous contralateral adrenal metastases.

Myoid Hamartoma of the Breast with Synchronous Contralateral Breast Cancer: Report of a Case / 한국유방암학회지

Myoid hamartomas of the breast parenchyma are extremely rare, benign breast neoplasms. Only 15 cases of the parenchymal myoid hamartoma of the breast have currently been described in the medical literature written in English. A 46-year-old woman presented with a huge right breast myoid hamartoma and synchronous contralateral left periareolar cancer. We discuss the clinical features, the radiologic findings, the pathologic findings and the management of this type of lesion. Surgeons should be aware that myoid hamartoma is a rare benign tumor, but it can be the cause of a palpable mass in the breast.

Myoid Hamartoma of the Breast with Synchronous Contralateral Breast Cancer: Report of a Case / 한국유방암학회지

Myoid hamartomas of the breast parenchyma are extremely rare, benign breast neoplasms. Only 15 cases of the parenchymal myoid hamartoma of the breast have currently been described in the medical literature written in English. A 46-year-old woman presented with a huge right breast myoid hamartoma and synchronous contralateral left periareolar cancer. We discuss the clinical features, the radiologic findings, the pathologic findings and the management of this type of lesion. Surgeons should be aware that myoid hamartoma is a rare benign tumor, but it can be the cause of a palpable mass in the breast.

Synchronous Papillary Tumor of the Fallopian Tube and Endometrium: A Case Report

Synchronous tumor of the fallopian tube and endometrium is an unusual co-occurrence of gynecologic malignancies. To the best of our knowledge, there have been no reports on synchronous papillary tumor of the fallopian tube and endometrium. In this report, we present the case of a patient who synchronously suffered with papillary serous adenocarcinoma of the fallopian tube and endometrium and the tumor showed characteristic frondlike projections on magnetic resonance imaging.

Male Patients with the Diagnoses of Synchronous Prostate and Breast Cancer / 대한비뇨기과학회지

Prostate cancer and male breast cancer are similar in many ways, including the potential role of steroidal hormones in their pathogenesis and shared genetic abnormalities. However, the combination of these cancers in the same patient is rare. Herein, the case of a male patient, diagnosed with synchronous prostate and breast cancers, is reported.

A Case of Synchronous Mucinous Tumor of the Ovary and Appendix / 대한산부인과학회잡지

The coexistence of mucinous ovarian and appendiceal tumors in associated with pseudomyxoma peritonei is well established. But, ovarian and appendiceal mucinous tumors occur without involvement of other organs is unusual. When the two lesions are morphologically similar, it is difficult to determine whether one reflects a metastasis or whether the tumors are independent. The typical synchronous presentation of the ovarian and appendiceal tumors, their histologic similarity, the frequency of bilaterality of the ovarian tumors, the predominance of right-sided ovarian involvement. Adenocarcinoma of the appendix constitutes 0.2 to 0.5 percent of all gastrointestinal tumors and accounts for 6 percent of primary malignant lesion of the appendix. The authors experienced a rare case of synchronous tumor of ovary and appendix in 59 years old female patient who has suffered for 3-4 months from abdominal pain. Pathologic examination of the resected specimen revealed a synchronous mucinous type tumor of vermiform appendix and ovary.