[Laryngeal carcinoma, testicular neoplasms and non-Hodgkin's lymphoma. A new case of multiple primary neoplasms].
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The anogenital region, comprising the cervix, vagina, vulva, perineum, and anus, has the potential for the development of multicentric and multiple primary malignancies. Fifteen patients with 3 or more primary neoplasms in this region are presented. Awareness of the existence of these tumors as a regional disease and the possible long intervals between successive malignancies are emphasized. The presence of a vulvar neoplasm should arouse suspicion of a synchronous primary tumor elsewhere in the region. Conversely, sequential neoplasms occur more commonly after an initial cervical primary neoplasm and should be anticipated.
There were 970 patients who were diagnosed as having genitourinary cancer at Yamagata Prefectural Central Hospital between 1975 and 1990, and of whom 100 cases (10.3%) had multiple primary malignant neoplasms in addition to their genitourinary cancer. They were compared with 220 patients having single genitourinary cancer and 274 having benign prostatic hypertrophy without past histories of cancer. The genitourinary organs involved with cancers included the prostate (50 patients), urinary bladder (43 patients), ureter or renal pelvis (15 patients) and kidney (7 patients). In the prostate cancer, the incidental carcinomas occupied 30%. The other organs accompanying the genitourinary cancers included the stomach, lung and colon. In patients of multiple primary cancers, single genitourinary cancer and benign prostatic hypertrophy, positive family histories for cancer were observed in 40.0%, 37.7% and 33.2%, respectively, with no significant difference between these groups. Histories of smoking were observed in 54.0%, 38.2% and 34.3% respectively, with significant difference between the multiple primary neoplasm patients and the other 2 groups (p < 0.01). There were two cases in whom the second cancer could be possibly caused by the exposure to radiation for the first cancer. No oncotherapeutic drugs or occupational exposure could be seriously suspected of the cause of the second cancers in the present cases.
The Authors, after a short review of the literature on the subject, with particular emphasis to statistics, pathogenesis and diagnostic criteria, describe a case of the onset of multiple primary malignant neoplasms in a 90 years old woman they followed in various hospital admittances. Thereafter, they discuss the possible consequences arising from the recognition of this clinical picture.
INTRODUCTION: The finding of more than one carcinoma throughout the life of a patient is not unusual. In fact, the occurrence of multiple primary cancers has been well documented. However, the features, implications and prognosis of colorectal cancers associated to other malignancies, have been less well documented. PATIENTS AND METHOD: We report 29 patients with multiple primary neoplasms in which at least one of them was a colorectal cancer. Number, extension and localization of colonic neoplasm, and time interval between diagnosis of both neoplasms, and mortality and survival rate were retrospectively analyzed. Follow-up ranged from 1 to 360 months. RESULTS: Twenty three patients had two cancers, and six more than three neoplasms. Colorectal cancer was primary in 8 patients, metachronous in 14 patients and synchronous in 5 patients. Breast (7 cases), prostate (5 cases), endometrium (3 patients) and stomach (3 cases), were the other malignancies most frequently detected. Overall, 13 of the 27 patients (49%) died during the follow-up period after the recognition of the colorectal cancer. Two patients were lost to follow-up. Mantel-Haenszel test did not show significative differences in survival between patients with two or more neoplasms. There were no differences in survival depending upon the timing of diagnosis of the colorectal tumor. CONCLUSIONS: These data suggest that colorectal cancer may share etiologic factors with hormone-dependent neoplasms (breast, prostate) and gastric cancer. In patients with primary multiple neoplasms, the number of neoplasms detected and the interval time between both diagnosis are not prognostic factors when one of the malignancies in colorectal cancer.
A case of two histologically different contemporary multiple primary cancers of the breast and the oral cavity is reported. The clinical and histopathological description of the lesions is completed by a discussion on the most recent reported data.
The current study follows up the 983 patients who were diagnosed as having prostate cancer at the Columbia-Presbyterian Medical Center in New York City between 1970 and 1979 and of whom 106 (11.5%) developed a multiple primary malignant neoplasm (MPMN) in addition to their prostate cancer by January 1, 1986. Of the 283 black patients, 32 (11.3%) developed an MPMN involving 35 sites excluding prostate. Of the 636 white patients, 74 (11.6%) developed an MPMN in association with their prostate cancer. Comparing observed incidence rates to expected on the basis of SEER incidence data, two malignant tumors, urinary bladder cancer and malignant lymphoma, appeared to occur in excess in the present series of patients. The excess of urinary bladder cancer in our series could be explained by detection bias due to the routine use of cystoscopy. The excess incidence of lymphoma in our series appears significant but its etiology is unexplained.
The study group included 2161 patients operated on in 1968-1990. Tumors stage I were morphologically confirmed in 910 cases (T1S-3, T1-375 and T2-532). 827 patients survived 5 years (90.9%); 551 patients-10 years (60.3%). Primary multiple neoplasms (PMN) of different localization were detected in 96 (10.6%) patients with stage I tumors. Thirteen patients (13.5%) died of progression of a second tumor; 17 (17%)-of other causes. Average 5-year survival was 65%, 10 years-53%. These indices in 96 patients with PMNs were 73 and 53%, respectively. Relative risk of PMN in lung cancer was found to be in direct correlation with survival time and to depend, to a large degree, on tumor extension. When PMNs are detected early and treated radically, new primary tumors emergence does not significantly in lung cancer stage I. Preliminary results showed chemotherapy (neoadjuvant one included) to lower the risk of PMN in lung cancer stage I. The most plausible causes of enhanced survival of patients with PMNs are discussed.
During the 10-year period (1987-1996) of our study, 26,255 patients with cancer were admitted to our clinic and, of these, 271 (1%) patients had multiple primary malignant tumors. Ninety-two (34%) patients had synchronous tumors (synchronous group), and 179 (66%) patients had metachronous tumors (metachronous group). The mean age at first diagnosis was higher in the former group. The ratio of men to women was 1.36 in the synchronous group and 0.74 in the metachronous group (p = 0.018). Smokers and drinkers were more common in the synchronous group. Breast cancer and lung cancer were most prevalent, and associations between head/neck and lung cancer and between breast and breast cancer were the most frequent associations in both the synchronous and the metachronous group. The frequency of aerodigestive tumors was higher and that of mesenchymal tumors was lower in the synchronous group than in the metachronous group. Localization in the medial region and in the head/neck was more frequent in the synchronous group than in the case of metachronous secondary tumors.
The association between meningioma and a primary malignant neoplasm at another site was studied. The data from the population-based Norwegian Cancer Registry were analysed according to whether the meningioma occurred before or after the malignant neoplasm. Male patients with meningioma showed a raised risk for developing a subsequent renal cancer. A significant association was found between meningioma and subsequent breast cancer in females 50-64 years old at time of meningioma diagnosis and between breast cancer and subsequent occurrence of meningioma. Breast cancer patients with symptoms of an intracranial neoplasm may therefore have a potentially curable meningioma and female meningioma patients over 50 years should be considered for breast cancer screening programmes.
The authors present follow-up data on 227 patients with laryngeal cancer. All the patients have received radical treatment. Long- and short-term responses are analyzed with special emphasis on patients with multifocal lesions (12 patients with cancer of the larynx and other organs).
The analysis of 49 cases of synchronous and metachronous malignant mucinous tumors of the colon (rectum) and ovaries in the patients treated in 1990 to 2004 again has confirmed the data that metastatic ovarian cancer occurs from a primary focus in the colorectal region. Immunohistochemical studies (using cytokeratin 7 and cytokeratin 20) may be used in the differential diagnosis of ovarian mucinous ovarian carcinoma from metastatic colonic mucinous tumors.
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DNA mismatch repair genes, hMLH1 and hMSH2, assigned on chromosome 3p21-23 and 2p21-22 are involved in hereditary non-polyposis colorectal cancer (HNPCC). The heterozygous carrier of the mutated allele results in a mutator phenotype and accelerating tumorigenesis, which especially causes carcinomas in the gastrointestinal and genitourinary tracts. We screened germline mutations of mismatch repair genes hMLH1 and hMSH2 in a patient with multiple primary neoplasms (multiple stomach cancers, colon cancer and brain tumor) in a cancer clustered HNPCC family. Screening by long RT-PCR from the RNA extracted from puromycin-treated heparinized blood showed skipping of the exon 2 in hMLH1. The analysis of the genomic DNA showed a GT deletion in the splice-donor site of the exon 2, which is compatible with the splicing variant detected by long RT-PCR analysis. This is a novel germline mutation that has not been reported previously.
The patient without oncologic family history with three primary neoplasms is presented in this article. Cancers were diagnosed and successfully treated during 12 years-long observation time. There were endometrial uterus cancer, breast cancer and thyroid cancer in tum.
Of the 3182 patients with malignant tumors of the large intestine, in 140 (4.4%), the primary multiple malignant neoplasms were revealed: in 59 (42.1%) of them--the synchronous, in 81 (57.9%)--the metachronous ones. Surgical treatment was performed in 137 (97.9%) patients, including the radical treatment--115 (83.9%). The postoperative lethality was 7.3%. 75.3% of the patients are alive for five years, 21.3%--for ten years.
The authors have presented a very rare case of multiple primary neoplasms of parotid gland: adenolymphoma and squamous cell carcinoma. Primary multiple neoplasms and multifocal neoplasms are a very complex problem and therefore have been a topic of many articles. The authors describe mechanism of origin, frequency of occurrence, possibilities of diagnostics. The main reason of these neoplasms origin are simultaneously exposure of the tissue to damaging factors and special tissue sensitivity.
Multiple primary neoplasm has developed in 70 patients with head and neck cancer who were treated in Otorhinolaryngology Department Medical Academy in Warsaw. Two primary neoplasm has been recognised in 63 patients, three independent tumors in 7 patients. The most common site for a first tumor was laryngeal carcinoma, for a second - lung, skin and tongue. The squamous cell carcinoma was the most common in the first as well as in the second malignancies.