ABSTRACT
BACKGROUND Multiple primary malignancy (MPM) is defined as 2 or more primary malignancies diagnosed in the same patient. Even though MPMs are rare, various associated tumors have been reported in the literature. We report the first case of triple synchronous primary malignancies: gastrointestinal stromal tumor, colon adenocarcinoma, and renal cell carcinoma. CASE REPORT A 63-year-old man presented to our emergency department with a 7-day history of diffuse abdominal pain and constipation. Examination revealed a distended abdomen and diffuse tenderness. Enhanced computed tomography showed a high-grade large bowel obstruction with the transitional zone seen at the splenic flexure, which was suspicious for primary colon cancer, and a hypodense lesion on the left mid-pole of the kidney. An emergency exploratory laparotomy revealed a splenic flexure mass, which was resected, and a left renal mass, which was excised. A stomach mass at the greater curvature was an incidental intraoperative finding; a wedge resection was performed for it. The pathology for each of the masses showed a primary malignancy. CONCLUSIONS Multiple primary cancers are rare and a multidisciplinary team approach is essential for management of these patients, be it preoperative, intraoperative, postoperative, or long-term surveillance.
Subject(s)
Kidney Neoplasms , Neoplasms, Multiple Primary , Abdomen , Colon , Humans , Kidney , Kidney Neoplasms/complications , Kidney Neoplasms/surgery , Male , Middle Aged , Neoplasms, Multiple Primary/surgery , StomachABSTRACT
OBJECTIVES: Vitamin D deficiency leads to a myriad of healthcare problems from cardiovascular, metabolic, endocrine, and neurological disorders to cancer. However, the role of vitamin D deficiency in the etiopathogenesis of polycystic ovary syndrome (PCOS) is unclear. This study aimed to measure objectively the impact of vitamin D deficiency on PCOS through a quantitative assessment of the existing literature. METHODS: We conducted a systematic search of published literature on the following online databases using EndnoteX7: MEDLINE, EBSCO, ScienceDirect, and CINAHL. Searches were limited to full-text English-language journal articles published between 2006 and 2016. Eligible clinical studies employed control group data to investigate the association between vitamin D deficiency and PCOS. RESULTS: We identified 10 studies eligible for this meta-analysis. The summary intervention effect calculated for this meta-analysis yields a value of -0.45 with a confidence interval of -1.68 to 0.79, supporting the hypothesis that lower concentrations of serum vitamin D play a role in the hormonal and metabolic dysregulation seen in PCOS. CONCLUSIONS: Lower concentrations of serum vitamin D are associated with a greater risk of developing PCOS. However, the therapeutic effect of vitamin D in the setting of PCOS remains unclear and must be determined by future interventional studies.
