A case of successful conversion surgery for locally advanced pancreatic cancer with synchronous triple cancer of the lung and esophagus: a case report.

BACKGROUND: The number of reports of multiple primary cancer (MPC) is increasing because of the advancement in diagnostic imaging technology. However, the treatment strategy for MPCs involving pancreatic cancer is controversial because of the extremely poor prognosis. We herein report a patient with synchronous triple cancer involving the pancreas, esophagus, and lung who underwent conversion surgery after intensive chemotherapy for unresectable locally advanced pancreatic cancer. CASE PRESENTATION: A 59-year-old man was admitted to our hospital with epigastric pain, anorexia, and weight loss. Computed tomography and upper gastrointestinal endoscopy revealed that the patient had synchronous triple cancer of the pancreas, esophagus, and lung. While the esophageal and lung cancer were relatively non-progressive, the pancreatic tail cancer had invaded the aorta, celiac axis, and left kidney, and the patient was diagnosed with unresectable locally advanced disease. Because the described lesion could have been the prognostic determinant for this patient, we initiated intensive chemotherapy (gemcitabine plus nab-paclitaxel) for pancreatic cancer. After six courses of chemotherapy, the tumor size shrank remarkably and no invasion to the aorta or celiac axis was observed. No significant changes were observed in the esophageal and lung cancers; endoscopic submucosal dissection could be still a curative treatment for the esophageal cancer. Therefore, we performed curative resection for pancreatic cancer (distal pancreatomy, splenectomy, and left nephrectomy; ypT3N0cM0, ypStage IIA, UICC 8th). Pathologically, complete resection was achieved. The patient then underwent endoscopic submucosal dissection for early esophageal cancer (pT1a[M]-LPM) and video-assisted thoracoscopic right upper lobectomy in combination with right lower partial resection for early lung cancer (pT2aN0M0, pStage IB, UICC 8th). Eight months after pancreatic cancer surgery, the patient is alive and has no sign of recurrence; as a result of the successful treatment, the patient has a good quality of life. CONCLUSIONS: Treatment of MPC is challenging, especially for cases with unresectable tumors. Although synchronous triple cancer can involve unresectable pancreatic cancer, radical resection may be possible after careful assessment of the appropriate treatment strategy and downstaging of unresectable tumors.

Synchronous Primary Endometrial and Fallopian Tube Carcinoma with Metchronous Renal Pelvis Carcinoma in One Patient: "Triple Cancer- A Rare Occurrence".

Triple primary cancers in one patient are a very rare finding and occur in only 0.5% of patients with cancers. Here, we report the case of triple malignancy in a 62-year-old woman who developed synchronous primary endometrial endometroid type and serous type of fallopian tube carcinoma, which is again a rare finding after 4 years of diagnosis of transitional cell carcinoma of the right renal pelvis.

Simultaneous triple cancer of the esophagus, pancreas and rectum treated with multimodal strategies: a case report.

BACKGROUND: Due to the development of diagnostic imaging technology, we have increased chance of detecting multiple primary cancers. However, simultaneous triple cancer is still a very rare finding whose frequency is not yet known. Treatment of simultaneous triple cancer is a clinical challenge because it requires multimodal strategies including surgery, chemotherapy and radiotherapy. CASE PRESENTATION: Here, we present the case of a 74-year-old male with triple cancer involving esophageal and pancreatic cancer, and rectal carcinoma. Each cancer was surgically resectable, but simultaneous resection of all cancers seemed to cause too much surgical stress for the patient. First, we performed a laparoscopic Hartmann's operation for rectal cancer to minimize the risk of postoperative complications. Then treatment for pancreatic cancer was initiated by administering neoadjuvant chemotherapy with gemcitabine plus nab-paclitaxel. The pancreatic tumor shrank in size, so pancreatoduodenectomy was performed. We chose S-1 as adjuvant chemotherapy. The esophageal cancer showed regression during the treatment of the other two cancers, likely because the chemotherapeutic agents administered for pancreatic cancer had some effect on the esophageal cancer. Definitive chemoradiotherapy was selected instead of esophagectomy because the patient had already undergone two major surgeries. The patient is still alive nine months after the whole course of treatment with no sign of recurrence. CONCLUSIONS: The treatment of triple cancer requires an elaborate strategy to determine which cancer has to be dealt with first and which can be treated later. An aggressive multimodal treatment strategy may be an important option for a patient with triple cancer.

Synchronous triple squamous cell carcinoma of the esophagus.

BACKGROUND: Synchronous multiple primary malignancies of the esophagus and other organs are relatively unusual, but only five articles have published two synchronous cancers, both in the esophagus. This is the first published case of a triple esophageal carcinoma. CASE REPORT: A 43-year-old man was referred to our hospital with severe progressive dysphagia and epigastric pain for almost one year. Endoscopy and imaging exams revealed three tumors located in upper, middle and lower esophagus. The upper and middle esophageal cancers were irresectable, and the patient was treated with radio- and chemotherapy. He survived 11 months after the diagnosis and died due to severe undernutrition and bilateral pneumonia. CONCLUSION: In presence of squamous cell carcinoma of the esophagus, propedeutics should be carefully performed in order to verify the occurrence of other synchronous tumors in the esophagus and other organs, mainly head and neck and bronchial regions.

Triple synchronous invasive malignancies of the female genital tract in a patient with a history of leukemia: A case report and review of the literature.

BACKGROUND: Three primary synchronous cancers in the female genital tract are extremely rare. In the literature, only four studies have described three different invasive gynecologic cancers of epithelial origin identified simultaneously in the same patient. CASE PRESENTATION: This is the first case in the literature that reports on triple primary ovarian, endometrial and endocervical cancers in a 38-year-old woman with a history of previously treated malignant disease (acute lymphatic leukemia). With a preoperative diagnosis of endocervical adenocarcinoma stage Ib1 (according to International Federation of Gynecology and Obstetrics-FIGO), as well as an adnexal mass, she underwent radical hysterectomy with bilateral adnexectomy. Pathologic examination of the surgical specimen revealed a mucinous adenocarcinoma of the cervix, an endometrioid adenocarcinoma of the uterine corpus, and a mucinous adenocarcinoma of the left ovary. Eighteen months after appropriate treatment, the patient is free of disease. CONCLUSION: The incidental diagnosis of more than one tumor is often a post-operative finding, usually with the detection of low-stage neoplasms. Multiple synchronous gynecologic cancers have a better prognosis than metastatic or advanced primitive disease. In a patient with multiple neoplasms, the prognosis is determined by the tumor with the worst prognosis.

Effectiveness of FDG-PET in screening of synchronous cancer of other organs in patients with esophageal cancer.

AIM: We investigated the significance of pre-treatment screening by (18)F-fluorodeoxyglucose positron-emission tomography (FDG-PET) in patients with esophageal cancer. PATIENTS AND METHODS: We retrospectively evaluated the clinical significance of screening in 200 patients with primary esophageal cancer using FDG-PET. RESULTS: Out of 200 patients, 34 (17%) had synchronous multiple primary tumors; 31 patients had two types of cancers (15.5%) and three patients had three types (1.5%). The 37 second and third primary tumors were 13 stomach cancers (35.1%), 13 head and neck cancers (35.1%), seven colon (18.9%) and two lung (5.4%) cancers. When PET was performed at initial treatment for esophageal cancer, the diagnostic sensitivity of FDG-PET/Computed tomography (CT) for the second and third synchronous primary cancer were 53.8% (7/13) for the stomach; head and neck, 61.5% (8/13); colon, 42.9% (3/7); and lung, 50% (1/2), for an overall sensitivity of 54.1% (20/37 sites). CONCLUSION: FDG-PET/CT for patients with esophageal cancer may find both metastases from the primary esophageal cancer and other types of synchronous primary cancers.

Triple simultaneous primary invasive gynecological malignancies: a case report.

Double gynecologic cancer (primary cancers in two organs) is relatively rare. However, triple gynecologic cancer (primary cancers in three organs) is extremely rare. We experienced a case of triple cancer, with primary cervical, endometrial and ovarian cancers, each showing different histopathological features. A 50-year-old woman with a preoperative diagnosis of cervical cancer stage Ib1 with a pathological diagnosis of mucinous adenocarcinoma underwent radical hysterectomy. The pathological diagnoses of the extracted masses were endometrioid adenocarcinoma in the uterine corpus and serous adenocarcinoma in the left ovary. Consequently, triple cancer was diagnosed. After the operation, six cycles of a paclitaxel/carboplatin regimen were administered, and no relapse of the cancers has been observed to date. To our knowledge, this is only the second case report in the international literature of concurrent gynecologic triple cancers of epithelial origin; that is, invasive cervical, endometrial and ovarian cancers, each with different histopathological features.

Cáncer primario múltiple sincrónico: a propósito de un caso / Synchronous multiple primary cancer: report of a case

Los tumores malignos primarios múltiples sincrónicos son relativamente inusuales, aunque el número de pacientes diagnosticados con tumores primarios múltiples se está incrementando, dado al desarrollo de procedimientos diagnósticos más sofisticados, invasivos o no invasivos, y el incremento del número de pacientes ancianos. Los canceres sincrónicos al triple fueron reportados en solo el 1,2-1,9% de todos los canceres primarios. Los órganos digestivos son el sitio más común para tumores malignos primarios múltiples y también es el sitio usual del tumor primario. Nosotros describiremos los síntomas, diagnostico y tratamiento de un paciente masculino de 65 años con tumores gástricos malignos múltiples sincrónicos asociado a un cáncer de esófago.

Synchronous multiple primary malignant tumors are relatively unusual, although the number of patients diagnosed with multiple primary tumors is increasing due to development of more sophisticated invasive and non-invasive diagnostic tools and an increase in the number of elderly patients. Synchronous triple cancers were reported in only 1.2-1,9% of all primary cancers. Digestives organs are the most common tumor site for multiple primary malignant tumors and also the usual site for primary tumors. We will describe the symptoms, diagnosis and treatment of a 65 year-old male patient with synchronous gastric malignant tumors associated with esophageal cancer.

A Case of Triple Cancers of the Esophagus, Stomach and Duodenum / 대한소화기내시경학회지

Multiple primary cancer is defined as the multiple occurrence of malignant neoplasm in the same individual. The incidence of multiple primary cancer is 0.26~1.43% in Korea, but this malady is increasing due to development of diagnostic modalities, the treatment of cancer and the recording of accurate cancer statistics. The most common site of multiple primary cancer in Korea is the stomach, colon, breast, cervix, liver and lung. We report here on a case of triple cancer that was located at the middle esophagus, stomach and duodenum in 75 year-old man.

A Case of Synchronous Triple Primary Cancer of Gastric Adenocarcinoma, Carcinoid Tumor of the Ampulla of Vater and Renal Cell Carcinoma / 대한소화기내시경학회지

Multiple primary cancer is defined as the multiple occurrence of malignant neoplasm in the same individual. Synchronous cancers are usually defined as finding the second cancer at the same time or within a 6-month period after the diagnosis of the primary lesion, and metachronous cancers are found at more than 6 months after the initial diagnosis. Multiple primary cancers have been increasing reported on due to prolonged lifespans and the improvement of diagnostic techniques. Nevertheless, triple synchronous cancers have been regarded as a relatively rare finding. We report here on an unusual case of triple synchronous cancer of early gastric cancer, carcinoid tumor of the ampulla of Vater and renal cell carcinoma.

Metachronous Triple Primary Cancers

Multiple primary cancer is defined as the multiple occurrence of malignant neoplasms in the same individual. According to the development of new diagnostic techniques and the increase in long-term survivals, reports of multiple primary cancer have been gradually increasing among patients treated for initial cancers. Since Theodor Billroth reported the first three cases of multiple primary cancer in 1889, there have been many reports of multiple primary cancer, with an incidence range in Korea of 0.35~1.84%. In Korea, there have been a few reported cases of triple cancer. Herein, three recently experienced cases of metachronous triple primary cancer are reported.

A Case Report of Synchronous Double Primary Liver Cancers Combined with Early Gastric Cancer

Combined hepatocellular carcinoma and cholangiocarcinoma is found at a frequency of 1.0~6.3% in resected primary hepatic tumors. However, the case of double cancers of hepatocellular carcinoma and cholangiocarcinoma that are discovered synchronously in different lobes of a liver is very rare. We experienced a case of a 74-year-old man who was found to have hepatocellular carcinoma and cholangiocarcinoma in different lobes of the liver, which were accompanied by early gastric cancer. To our knowledge, this is the first case report of double primary hepatic cancers accompanied with early gastric cancer. The pathogenesis and previous related reports of these lesions are discussed.

A Case of Synchronous Primary Triple Cancers Including Stomach, Esophagus and Liver / 대한소화기내시경학회지

Multiple primary malignant cancer is a disease of more than two cancers occuring in an individual independently. The incidence of multiple primary malignant cancer is increasing gradually due to accurate cancer statistics, early diagnosis and treatment. Multiple primary malignant cancer may be divided into two groups, synchronous or metachronous depending on the interval between their diagnoses. Synchronous cancer is diagnosed simultaneously or within an interval of 6 months and metachronous cancer at interval of more than 6 months. Here, we report a case of synchronous primary triple cancers including stomach, esophagus and liver. The patient was a 63-year-old man with dysphagia. We performed endoscopy, chest and abdominal CT. We found cancers in stomach, esophagus and liver and confirmed triple primary cancer through endoscopic biopsy and sono-guided liver biopsy.

Two Cases of Triple Gastric Cancer / 대한소화기내시경학회지

Multiple gastric caner, now considered to be a sort of multiple primary cancer by Moertel's classification, is a special type of cancer in which two or more tumor lesions arise independently from the stomach. Although its incidence is rare and it has never been reported in Korea yet, the report of multiple gastric cancer is increasing with lengthened life survival and improved diagnostic method. We recently experienced two cases of triple gastric cancer, the one in 53-years-old male who had well differentiated adenocarcinoma(EGC IIb+c) on antrum, poorly differentiated adenocarcinoma on cardia and moderately differentiated adenocarcinoma on mid-body, and the other in 65-years-old female who had two poorly differentiated adenocarcinoma on cardia and anterior wall of low body and moderately differentiated adenocarcinoma (EGCIIc) on posterior wall of low body. Triple gastric cancer is rare, so we reported 2 cases of triple gastric cancer.