Multiple primary tumors in a single patient
No Thumbnail Available
Date
2023
Authors
Journal Title
Journal ISSN
Volume Title
Publisher
Rīgas Stradiņa universitāte
Rīga Stradiņš University
Rīga Stradiņš University
Abstract
Ievads. Vairāku primāro audzēju attīstība kļūst biežāka, jo ir pieaugusi vēža pacientu dzīvildze, kā arī uzlabojušās skrīninga programmas un diagnostikās metodes. Metahronus audzējus definē kā ļaundabīgus audzējus, kas diagnosticēti vairāk nekā 6 mēnešu intervālā, ja tie attīstās dažādās lokalizācijās. Vairāku primāro audzēju sastopamības biežums ir 2-17%.
Klīniskais gadījums. 83 gadus vecs vīrietis sūdzas par 3 nedēļas ilgām vēdera sāpēm, galvenokārt vēdera augšdaļā, izteiktāk vakaros pēc ēšanas, kā arī dispepsijas simptomiem un svara zudumu.
Datortomogrāfijas atradnē vērojams tievo zarnu ileuss ar obstrukciju ileocekālajā līmenī un brīvo šķidrumu iegurnī.
Tika veikta laparotomija, kurā atklāta obstruktīva neoplāzija cekālajā rajonā, pēc kuras seko labās puses hemikolektomija un D2 limfmezglu disekcija.
Pēcoperācijas periods noritēja bez sarežģījumiem. Histopatoloģijas izmeklējumā konstatēta vidēji diferencēta resnās zarnas ascendējošās daļas adenokarcinoma.
Šis bija pacienta ceturtais primārais audzējs.
2004. gadā pacientam tika ekscidēta melanoma no muguras. Viņš saņēma imūnterapiju.
2014. gadā pamanīts veidojums kakla labajā pusē. Tika veikta limfmezgla konglomerāta ekscīzija, un atklāta augstas pakāpes ļaundabīga B šūnu limfoma.
2015. gadā pēc ķīmijterapijas saņemšanas PET CT tika atrasts audzējs rektosigmoidālā pārejā. Tika veikta laparotomija ar sigmveida zarnas resekciju un atklāta mēreni diferencēta adenokarcinoma.
Pēc 7 gadiem remisijā, viņš atgriezās ar iepriekš minēto patoloģiju.
Secinājumi. Pacientu skaits ar metahroniem ļaundabīgiem audzējiem pieaugs, pateicoties diagnostikai, pieejamai ārstēšanai, ilgākam mūžam. Ārstiem rūpīgi jāveic pacientu izmeklēšana un novērošana, kam varētu būt izšķiroša nozīme jaunu audzēju diagnostikā.
Introduction. The development of multiple primary tumors is becoming more frequent due to the prolonged survival time of cancer patients, and improvement in screening programs and diagnostic techniques. Metachronous tumors are defined as malignancies diagnosed in an interval of more than 6 months if arising in different sites. The frequency of multiple primary tumors is reported in the range of 2–17%. Case report. An 83-year-old male presented with abdominal pain for 3 weeks mainly in the upper abdomen, more prominent in the evenings after eating. He also presented with dyspeptic symptoms and weight loss. Computed tomography scan revealed small bowel ileus with an obstruction in the ileocecal region and free fluid in the pelvis. A laparotomy was performed and obstructive neoplasia in the cecal region was discovered with a following right-side hemicolectomy and D2 lymph node dissection. The patient recovered uneventfully. The histopathology report showed a moderately differentiated adenocarcinoma of the ascending colon. This was the patient’s fourth primary tumor. In 2004 the patient had an excision of melanoma on his back. He received immunotherapy. In 2014 he noticed a mass on the right side of his neck. An excision of the lymph node conglomerate was done, and a high-grade malignant b cell lymphoma was revealed. In 2015 after receiving chemotherapy for lymphoma a PET CT scan showed a tumor in the rectosigmoid junction. A laparotomy with sigmoid colon resection was performed and revealed a moderately differentiated adenocarcinoma. Following 7 disease-free years he returned with the aforementioned pathology. Conclusions. The prevalence of patients with metachronous malignancies will rise due to a combination of factors – diagnostics, available treatment, and a longer life expectancy. Doctors need to remain vigilant and carefully perform patient evaluations which might be crucial in diagnosing additional tumors.
Introduction. The development of multiple primary tumors is becoming more frequent due to the prolonged survival time of cancer patients, and improvement in screening programs and diagnostic techniques. Metachronous tumors are defined as malignancies diagnosed in an interval of more than 6 months if arising in different sites. The frequency of multiple primary tumors is reported in the range of 2–17%. Case report. An 83-year-old male presented with abdominal pain for 3 weeks mainly in the upper abdomen, more prominent in the evenings after eating. He also presented with dyspeptic symptoms and weight loss. Computed tomography scan revealed small bowel ileus with an obstruction in the ileocecal region and free fluid in the pelvis. A laparotomy was performed and obstructive neoplasia in the cecal region was discovered with a following right-side hemicolectomy and D2 lymph node dissection. The patient recovered uneventfully. The histopathology report showed a moderately differentiated adenocarcinoma of the ascending colon. This was the patient’s fourth primary tumor. In 2004 the patient had an excision of melanoma on his back. He received immunotherapy. In 2014 he noticed a mass on the right side of his neck. An excision of the lymph node conglomerate was done, and a high-grade malignant b cell lymphoma was revealed. In 2015 after receiving chemotherapy for lymphoma a PET CT scan showed a tumor in the rectosigmoid junction. A laparotomy with sigmoid colon resection was performed and revealed a moderately differentiated adenocarcinoma. Following 7 disease-free years he returned with the aforementioned pathology. Conclusions. The prevalence of patients with metachronous malignancies will rise due to a combination of factors – diagnostics, available treatment, and a longer life expectancy. Doctors need to remain vigilant and carefully perform patient evaluations which might be crucial in diagnosing additional tumors.
Description
Medicīna
Medicine
Veselības aprūpe
Health Care
Medicine
Veselības aprūpe
Health Care
Keywords
metahroni audzēji, melanoma, limfoma, adenokarcinoma, metachronous malignancies, melanoma, lymphoma, adenocarcinoma