Multiple primary cancer: Report of two cases with synchronous lymphoma and carcinoma

Motlló, Cristina; Sant, Francesc; Altés, Albert

doi:10.1016/j.medcli.2019.11.016

array:23 ["pii" => "S0025775320301123" "issn" => "00257753" "doi" => "10.1016/j.medcli.2019.11.016" "estado" => "S300" "fechaPublicacion" => "2021-02-26" "aid" => "5096" "copyright" => "Elsevier España, S.L.U.. All rights reserved" "copyrightAnyo" => "2020" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "cor" "cita" => "Med Clin. 2021;156:199-200" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "itemSiguiente" => array:19 [ "pii" => "S0025775320301639" "issn" => "00257753" "doi" => "10.1016/j.medcli.2019.12.028" "estado" => "S300" "fechaPublicacion" => "2021-02-26" "aid" => "5128" "copyright" => "Elsevier España, S.L.U." "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "cor" "cita" => "Med Clin. 2021;156:200-1" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "es" => array:10 [ "idiomaDefecto" => true "cabecera" => "Carta al Editor" "titulo" => "Análisis de factores predictivos de mortalidad y evolución del paciente oncológico ingresado en cuidados intensivos" "tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "200" "paginaFinal" => "201" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Oncological patients admitted to an intensive care unit: Analysis and evolution" ] ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Cristina Márquez Romera, Valentín del Villar Sordo" "autores" => array:2 [ 0 => array:2 [ "nombre" => "Cristina" "apellidos" => "Márquez Romera" ] 1 => array:2 [ "nombre" => "Valentín" "apellidos" => "del Villar Sordo" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2387020621000139" "doi" => "10.1016/j.medcle.2019.12.015" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020621000139?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0025775320301639?idApp=UINPBA00004N" "url" => "/00257753/0000015600000004/v1_202102130626/S0025775320301639/v1_202102130626/es/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S0025775320301214" "issn" => "00257753" "doi" => "10.1016/j.medcli.2019.11.018" "estado" => "S300" "fechaPublicacion" => "2021-02-26" "aid" => "5105" "copyright" => "Elsevier España, S.L.U." "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "cor" "cita" => "Med Clin. 2021;156:198-9" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "es" => array:10 [ "idiomaDefecto" => true "cabecera" => "Carta al Editor" "titulo" => "Síndrome de distrés respiratorio agudo en el contexto de una neumonía comunitaria grave por Rothia mucilaginosa en un paciente inmunocompetente" "tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "198" "paginaFinal" => "199" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Acute respiratory distress syndrome due to severe community-acquired pneumonia caused by Rothia mucilaginosa in an immunocompetent patient" ] ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "José Ángel de Ayala Fernández, Jorge Galán Ros, Luis Tamayo" "autores" => array:3 [ 0 => array:2 [ "nombre" => "José Ángel" "apellidos" => "de Ayala Fernández" ] 1 => array:2 [ "nombre" => "Jorge" "apellidos" => "Galán Ros" ] 2 => array:2 [ "nombre" => "Luis" "apellidos" => "Tamayo" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2387020621000115" "doi" => "10.1016/j.medcle.2019.11.020" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020621000115?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0025775320301214?idApp=UINPBA00004N" "url" => "/00257753/0000015600000004/v1_202102130626/S0025775320301214/v1_202102130626/es/main.assets" ] "en" => array:12 [ "idiomaDefecto" => true "cabecera" => "Letter to the Editor" "titulo" => "Multiple primary cancer: Report of two cases with synchronous lymphoma and carcinoma" "tieneTextoCompleto" => true "saludo" => "Dear Editor," "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "199" "paginaFinal" => "200" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Cristina Motlló, Francesc Sant, Albert Altés" "autores" => array:3 [ 0 => array:4 [ "nombre" => "Cristina" "apellidos" => "Motlló" "email" => array:1 [ 0 => "cmotllo@althaia.cat" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Francesc" "apellidos" => "Sant" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "Albert" "apellidos" => "Altés" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Hematology Department of Hospital Sant Joan de Déu, Fundació Althaia, Manresa, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Anatomopathology Department of Hospital Sant Joan de Déu, Fundació Althaia, Manresa, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Cáncer primario múltiple: descripción de dos casos con linfoma y carcinoma sincrónicos" ] ] "textoCompleto" => "Diagnosis of contemporary cancer found during the extension study of one previous cancer is unusual but does occur and its importance lies in the impact on the prognosis and the way of acting from the clinical point of view.<a class="elsevierStyleCrossRef" href="#bib0030">1</a> These synchronous cancers have been named multiple primary cancer (MPC) and have been defined as having 2 or more malignant tumours, which are independent from each other without possibility of transfer and are all originated from different organs. These tumours must appear within 6 months.<a class="elsevierStyleCrossRef" href="#bib0035">2</a> Rarely, 3 or 4 cancers in a single patient have been described but its incidence remains low.<a class="elsevierStyleCrossRef" href="#bib0040">3</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">1</a> We describe two cases of MPC.Case 1. 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.Case 2. 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.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">4</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">1</a> Several cases have been described with synchronic haematological and oncologic malignant diseases.<a class="elsevierStyleCrossRefs" href="#bib0030">1–3,5</a> These are not the first case of Non-Hodgkin lymphoma and lung cancer described.<a class="elsevierStyleCrossRef" href="#bib0050">5</a> Cases with 2 different synchronic malignant hematologic diseases are less frequent.<a class="elsevierStyleCrossRef" href="#bib0030">1</a> The most important difficulty in cases with MPC is the therapeutic algorithm<a class="elsevierStyleCrossRef" href="#bib0030">1</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">1</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">1</a>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." "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. Lv" 1 => "X. Zhang" 2 => "Y. Shen" 3 => "F. Wang" 4 => "J. Yang" 5 => "B. Wang" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:4 [ "tituloSerie" => "Medicine" "fecha" => "2017" "volumen" => "96" "paginaInicial" => "e6799" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0035" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Multiple primary cancer: an experience at the Cancer Institute Hospital with special reference to colorectal cancer" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "M. Ueno" 1 => "T. Muto" 2 => "M. Oya" 3 => "H. Ota" 4 => "K. Azekura" 5 => "T. Yamaguchi" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s10147-003-0322-z" "Revista" => array:6 [ "tituloSerie" => "Int J Clin Oncol" "fecha" => "2003" "volumen" => "8" "paginaInicial" => "162" "paginaFinal" => "167" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12851840" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0040" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Synchronous primary sigmoid colon cancer and primary thyroid cancer followed by a malignant tumor of the kidney: case report of multiple primary cancer and review of the literature" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "C. Peng" 1 => "Z. Li" 2 => "H. Gao" 3 => "X. Zou" 4 => "X. Wang" 5 => "C. Zhou" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3892/ol.2018.9867" "Revista" => array:6 [ "tituloSerie" => "Oncol Lett" "fecha" => "2019" "volumen" => "17" "paginaInicial" => "2479" "paginaFinal" => "2484" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/30719116" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0045" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Therapy-related acute leukemia: study of 23 pacients" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "C. Motlló" 1 => "J.M. Sancho" 2 => "O. García" 3 => "I. Granada" 4 => "F. Millá" 5 => "J.M. 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. Ahmed" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:2 [ "tituloSerie" => "Case Rep Gastrointest Med" "fecha" => "2018" ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/00257753/0000015600000004/v1_202102130626/S0025775320301123/v1_202102130626/en/main.assets" "Apartado" => array:4 [ "identificador" => "66430" "tipo" => "SECCION" "es" => array:2 [ "titulo" => "Cartas al Editor" "idiomaDefecto" => true ] "idiomaDefecto" => "es" ] "PDF" => "https://static.elsevier.es/multimedia/00257753/0000015600000004/v1_202102130626/S0025775320301123/v1_202102130626/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0025775320301123?idApp=UINPBA00004N"]

ISSN: 0025-7753

Medicina Clínica, fundada en 1943, es la única publicación semanal de contenido clínico que se edita en España y constituye el máximo exponente de la calidad y pujanza de la medicina española. Son características fundamentales de esta publicación el rigor científico y metodológico de sus artículos, la actualidad de los temas y, sobre todo, su sentido práctico, buscando siempre que la información sea de la mayor utilidad en la práctica clínica. Los contenidos de Medicina Clínica abarcan dos frentes: trabajos de investigación original rigurosamente seleccionados atendiendo a su calidad, originalidad e interés, y trabajos orientados a la formación continuada, encomendados por la revista a autores relevantes (Editoriales, Revisiones, Conferencias clínicas y clínico-patológicas, Diagnóstico y Tratamiento). En estos artículos se ponen al día aspectos de destacado interés clínico o conceptual en la medicina actual. Medicina Clínica es un vehículo de información científica de reconocida calidad, como demuestra su inclusión en los más prestigiosos y selectivos índices bibliográficos del mundo.

Ver más Opción Open Access

Indexada en:

Current Contents/Clinical Medicine, Journal Citation Reports, SCI-Expanded, Index Medicus/Medline, Excerpta Medica/EMBASE, IBECS, IME, MEDES, PASCAL, SCOPUS, ScienceDirect