Letter to the Editor
Multiple primary cancer: Report of two cases with synchronous lymphoma and carcinoma
Cáncer primario múltiple: descripción de dos casos con linfoma y carcinoma sincrónicos
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These tumours must appear within 6 months.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> Rarely, 3 or 4 cancers in a single patient have been described but its incidence remains low.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> Those appearing more than 6 months later are called metachronous cancers. Its incidence is higher in males (2:1).<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> We describe two cases of MPC.</p><p id="par0010" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Case 1</span>. A sixty-one year old male patient with no relevant pathological antecedents but heavy smoker was remitted to hospital due to radiological image in right lung associated with toxic syndrome and nail clubbing. Computerized tomography (CT) scan confirmed a spiked medial right lung mass with no other masses or adenopathies, that suggested lung adenocarcinoma (ADK). Although lung biopsy was performed 3 times, diagnosis was no achieved. Cerebral magnetical resonance image (MRI) showed multiple focal lesions compatible with metastasis, and PET scan showed catchment in lung mass and both adrenal glands. Adrenalectomy was performed and allowed the diagnosis of diffuse large B-cell lymphoma (DLBCL). Treatment with chemotherapy according to R-CHOP schedule was started associated with high dose methotrexate in odd cycles in order to get to CNS. After six cycles the patient achieved complete response (Deauville 2) by PET and MRI. One month later, the patient consulted due to worsening of general status with lumbar pain and right mammary mass. Urgent PET/CT scan showed reappearance of the known right lung lesion as well as a new one in the left lung. MRI showed new captive lesions and the growth of, at least, 4 more CNS lesions. Lung biopsy was performed and the diagnosis of lung ADK was reached. The patient's performance status and the bad prognosis did not allow implementing chemotherapy treatment at that moment and patient died 12 months after the first symptom.</p><p id="par0015" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Case 2</span>. Asymptomatic splenomegaly and left pleural effusion were observed in routine control in a 60-year-old male smoker. CT scan done to complete the image study showed significant and left pleural effusion. Lymphadenopathy biopsy was performed and the patient was diagnosed with follicular lymphoma (FL) grade 1, stage IV-A, IPI 2 (intermediate risk). Treatment with R-CHOP was started. After cycle 3, routine CT scan was done to evaluate treatment response. It evidenced the disappearance of all lymphadenopathies and an increase of pleural lesions and the apparition of a new pleural mass which was biopsied and the diagnosis of carcinoma of unknown primary (CUP) was established. According to the new diagnosis, haematological disease was redefined as FL stage IIIA and IPI 2 with no treatment criteria and the patient received treatment for the oncologic disease.</p><p id="par0020" class="elsevierStylePara elsevierViewall">MPC are independent synchronous cancers that appear within 6 months. In contrast, second primary cancers can appear because of the improvement of long-term survival of several cancers due to improvement in treatments. The relation of several chemotherapy drugs and the appearance of therapy-related leukemias<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a> is well known. The most frequent sites for tumour localization in MPC seem to be the stomach, lung and oesophagus.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> Several cases have been described with synchronic haematological and oncologic malignant diseases.<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">1–3,5</span></a> These are not the first case of Non-Hodgkin lymphoma and lung cancer described.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a> Cases with 2 different synchronic malignant hematologic diseases are less frequent.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> The most important difficulty in cases with MPC is the therapeutic algorithm<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> that must decide which of the tumours is treated first. The first cancer that should be treated is the most aggressive, but the first cancer that is treated is frequently the one that was diagnosed first.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> The 1-year survival rate is 56% and the 3-year survival rate is 20.9% and the median survival time was 12 months (range 1–120).<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">These cases teach us that when diagnosis is uncertain, all necessary tests should be performed in order to diagnose all the diseases and give the patient the best treatment.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0030" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Clinical analysis and prognosis of synchronous and metachronous multiple primary malignant tumors" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M. 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Ribera" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Med Clin" "fecha" => "2011" "volumen" => "137" "paginaInicial" => "449" "paginaFinal" => "452" ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0050" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Simultaneous occurrence of colonic mucosa-associated lymphoid tissue (MALT) lymphoma (MALToma) and lung cancer" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "M. 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