A 62-year-old man with a complaint of back pain lasting 2 months was admitted. He also presented a huge abdominal tumor. Diagnostic imaging showed metastatic tumors in the liver, lumbar vertebrae and bilateral lung. An ultrasound-guided needle biopsy revealed a lung tumor containing melanic tissue. Subsequently, there was an evident elevation in uric acid, phosphoric acid, potassium and lactate dehydrogenase concentrations in serum. Continuous hemodiafiltration and administration of rasburicase was initiated following the diagnosis of tumor lysis syndrome (TLS). However, he died on the fourth day owing to arrhythmia. An autopsy revealed metastatic deposits in the liver, lung, spine, ribs, and lymph nodes along the biliary system. Microscopic examinations revealed massive necrosis of normal hepatocytes and tumor cells with disseminated tumor thrombi in the portal system. The catastrophic progression of TLS appears to be influenced by a persistent portal blood flow deficiency by portal tumor thrombus in this case.

Background: Double cancer is defined as the co-existence of two pathologically distinct cancers. Double cancer consisting of a lung adenocarcinoma and a malignant lymphoma has seldom been reported in time synchronous cases or prior to cases of primary lung cancer, except in those after treatment for malignant lymphoma. Case Presentation: Case 1 was a 71-year-old woman who was treated at our hospital for chronic hepatitis C, nontuberculous mycobacteria infection, and bronchiectasis. She was diagnosed with a stage IV lung adenocarcinoma (cT1bN2M1b) with a synchronous complicating diffuse large B-cell-type lymphoma. Case 2 was a 62-year-old man who had undergone resection of a stage IB lung adenocarcinoma (pT2aN0M0). Thirty months after the surgery, a diffuse large B-cell-type lymphoma was discovered. In both cases, high antiviral capsid antigen IgG antibody titers were observed. Conclusion: Epstein-Barr virus may be associated with the incidence of multiple cancers given the pathological evidence from our two double cancer cases.

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