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Due to progressive ageing of our population and increasing cancer incidence rates, more and more patients are presenting with multiple primary cancers. Here we describe a case of metastatic carcinoma involving the urinary bladder with underlying triple primary adenocarcinoma in a female adult.
A 67-year-old Taiwanese female presented to our institu...
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... of routine image studies during regular follow-up at our oncology clinic. In November 2011, she presented due to hematuria for several days. Diagnostic cystoscopy showed a mass lesion on the urinary bladder. Whole body computed tomography (CT) scan revealed an isolated 2.6 Â 2 cm tumor in the right posterior lateral wall of the urinary bladder (Fig. 1). Cystoscope-assisted biopsy showed a poorly differentiated adenocarcinoma with signet ring appearance arising from the submucosa of the urinary bladder. A metastatic cancer rather than primary urinary bladder cancer was impressed according to microscopic morphology of tumor and intact mucosa of urinary bladder. Immunohistochemical ...
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... reviewed specimens microscopically and immunohis- tochemically with a pathologist, and the urinary bladder lesion disclosed signet ring cell appearance ( Fig. 1) with CK7 (þ). We preliminarily determined that the cancer had originated from the stomach. However, in the following lymph node lesion, we compared samples of these recurrent lymph nodes with original gastric, breast and colon cancer tissue. Microscopically, lymph node tissue showed compact sheets and nests of carcinomatous cells ...
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... CK7 (þ) and HER-2-neu(polyclone): negative (1þ) (shown in Fig. 4A). Tracing back previous pathologic reports from gastric, breast and colon cancer, gastric tissue disclosed signet ring cells and some poorly differentiated cells scattered microscopically. IHC stain showed ER (À), PR (À), Her2 (À), CK7 (þ), CK20 (þ, partial) and CDX2 (À) (shown in Fig. 1). The patient's breast tissue revealed poorly differentiated cells diffusely infiltrating into the fibrous stroma and between the benign mammary glands. IHC stain showed ER (þþ, 100%), PR (þþ, 100%), HER-2-NEU (þþ, 100%), CK7 (þ), CK20 (À) and CDX2 (À) (shown in Fig. 4B). IHC stains from breast, gastric, urinary bladder and lymph node ...
Citations
... Second, he was a former heavy smoker and former frequent drinker (64,66). Finally, the patient had a family history of cancer (67,68). However, thymoma as SPT is not applicable to these theories because the underlying cause of the occurrence of thymoma remains unknown owing to its rarity (�1,�4,69). ...
The occurrence of second primary tumor (SPT)following malignancy treatment is common. In patients with head and neck (H&N) cancer, SPTs principally occur in the H&N region, lungs or esophagus. Therefore, patient follow-up after cancer treatment is important in order to detect recurrence, metastasis and new primary tumors. However, no standard guidelines on lifelong follow-up imaging are available. Herein, we report a patient who presented with three metachronous primary tumors-squamous cell carcinoma (SCC) of the tongue, SCC of the lip and type A thymoma. The third tumor was incidentally detected during follow-up using contrast-enhanced computed tomography (CT) 9 years following resection of the second tumor. To the best of our knowledge, this specific combination of metachronous tumors has not yet been reported. Based on the literature review, we observed that thymoma occurs following H&N cancer treatment. Therefore, to ensure that the presence of subsequent thymomas is not overlooked, we suggest regular lifelong follow-up using contrast-enhanced CT in patients who had previously been diagnosed with H&N cancer. The literature review revealed that thymomas occur in patients with H&N cancer and should be detected at the earliest convenience.
... Although a number of risks of SPC have been suggested to date, the risk of SPC is unclear (40). As the combination of triple PCs in the present study was unique, the risk factors may have included the administration of preoperative chemotherapy (41) and radiation postoperatively for index mandible cancer (41,42), the fact that the patient was a current drinker (41,43), a family history of gastric cancer in two brothers (44) and finally, the patient being a former smoker (43,45). The association between being a former smoker and secondary cancer risk in cancer survivors is unclear in the present case due to the cessation of smoking more than 40 years previously. ...
Second primary cancer (SPC) is an important prognostic factor for patients with head and neck cancer (HNC); therefore, the association between the prognosis and development of SPC has been well-reported. The use of 2-[¹⁸F]-fluoro-2-deoxy-D-glucose-positron emission tomography (FDG-PET) is valuable to examine cancer stage, evaluate treatment responses and investigate suspected relapses or metastases. In the present study, the case of a male patient who was diagnosed with three primary cancer types, including well to moderately differentiated squamous cell carcinoma (SCC) of the mandible, axillary cutaneous poorly differentiated SCC and prostate adenocarcinoma, was described. Among these, mandible cancer was the first diagnosed when the patient was 70 years of age. Synchronous skin and prostate cancer (PRC) types then developed 3 years later. To the best of our knowledge, this is the first report of the aforementioned combination of cancer types. Postoperative FDG-PET was not performed as no lesions of recurrence or metastases of mandible cancer were found. Three years later, the PRC was asymptomatic and was incidentally detected by FDG-PET performed for a preoperative evaluation of skin cancer. It was indicated that FDG-PET could be utilized in patients with HNC due to there being no accurate FDG-PET protocol to detect SPC over a long-term follow-up.
... The present case was initially diagnosed in 2003 and takes approximately 14 years metastasized to the urinary bladder after triple metastatic sites. Recently Hung et al. [9] published a case report of metastatic carcinoma of the urinary bladder in a 67-year-old female with underlying triple primary cancers. ...
Bladder metastasis from gastric cancer is a unique clinical entity, which can be revealed infrequently in patients with metastatic gastric cancer. Secondary neoplasms to the bladder are also a less frequent clinical entity representing only 15% of all bladder neoplasms. Gastric cancers consist of an exceptionally small percentage of all secondary bladder neoplasms. Until now only 27 cases were recorded in the international medical literature. The current work analyzes a 65-year old male patient who presented initially with a locally advanced gastric adenocarcinoma. He was treated with a combination of total gastrectomy and perioperative chemotherapy. Eight months later presented a relapse with bladder metastasis, liver metastasis and peritoneal involvement. Furthermore, in this manuscript, we conducted a review of the recorded cases with bladder metastasis from gastric cancer. In the most of cases the diagnosis of bladder metastasis was metachronous with an average time of presentation in four years after the primary diagnosis of gastric cancer and most of the patients of our review presented with urinary symptoms at the time of diagnosis of bladder metastasis. Concerning the management of the metastatic disease surgical management with total or partial cystectomy was performed in 11% of patients and TUR was performed in 22% of patients. Palliative chemotherapy for the management of metastatic disease was initiated in 46% of patients.
