Multiple Metachronous Malignancies, One Patient with Three Primary Malignancies

Abstract

Development of a primary cancer after treatment of the first with radiotherapy or chemotherapy is well documented, but it is common with hematological malignancies. Variety of reasons are suggested by various researchers, but a conclusive evidence is not yet available. Excepting a few correlations like the tamoxifen therapy and endometrial cancer, angiosarcoma of the breast following radiotherapy, occurrence of other metachronous malignancies seem to be dependent on genetic and environmental factors. A patient with three primary malignancies is presented here. Keywords Multiple malignancies . Metachronous . Gene disorders Case ReportA 54 year old female presented with a painless swelling in the anterior part of the neck for over 3 years' duration. On examination, the swelling was globular measuring about 3 cm in diameter in the region of right lobe of thyroid and was moving with deglutition. There was no retrosternal extension and cervical lymphadenopathy. A clinical diagnosis of thyroid adenoma was made. Right hemithyroidectomy was done, and the histopathology was minimally invasive follicular carcinoma of thyroid. She was suggested completion thyroidectomy which she refused. By the end of 1 year, she developed swelling of the left lobe, which on CT showed calcified deposits, and the FNAC showed scanty colloid material with follicular cells with no evidence of malignancy. She was lost to follow up since then.Five years after right hemithyroidectomy, she developed a malignant lump in the left breast, for which she underwent simple mastectomy with axillary clearance. Six courses of adjuvant chemotherapy (Cyclophosphamide, Epirubicin and 5 flurouracil) was given, and was advised to take Tamoxifen for 5 years.A year after mastectomy, during regular follow up, the abdominal ultrasound showed thickened endometrium of about 13 mm. On curettage, it was well differentiated adenocarcinoma, for which she refused any treatment. At this point, Tamoxifen was stopped and Letrozole was started.About 18 months after mastectomy, she developed hard nodules on the mastectomy scar, which were histologically proved to be infiltrating duct carcinoma. On further investigations, her CTs showed multiple hypodense lesions of varying size with variegated post contrast enhancement in the arterial phase in the liver, metastatic deposits in the lungs and pleural effusion (Fig. 1), though she remained asymptomatic. Only treatment she accepted was the local radiotherapy for the recurrent nodules, for which 56 Gy of radiation was given to the chest wall. In the meantime, she developed abdominal distension due to ascites, which showed malignant cells. She later succumbed to further complications. DiscussionMultiple metachronous primary cancers are known to occur in an individual, but it is often seen with hematological malignancies of childhood. The reasons are many; BRCA gene mutation, viral cause like HPV

Metachronous triple cancer associated with Peutz–Jeghers syndrome treated with curative surgery: a case report

“…This may lead to the development of MPM at some point during the lifetime [ 19 – 22 ]. Multiple metachronous malignancies are frequently detected in hematological, lung, thyroid, breast, skin, and genitourinary malignancies [ 23 , 24 ]. Liu et al investigated the etiological factors, clinical characteristics, diagnosis, treatment strategies, and prognosis of MPM and demonstrated that curative surgery has a strong impact on long-term prognosis [ 22 ].…”