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Year : 2020  |  Volume : 35  |  Issue : 2  |  Page : 174-175  

A case of metachronous triple carcinoma with synchronous double primary carcinoma on18F-fluorodeoxyglucose positron emission tomography-computed tomography


1 Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
2 Department of Pathology, All India Institute of Medical Sciences, New Delhi, India

Date of Submission22-Jan-2019
Date of Acceptance28-Feb-2019
Date of Web Publication12-Mar-2020

Correspondence Address:
Dr. Shamim Ahmed Shamim
Room No. 4, Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi - 110 029
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijnm.IJNM_19_19

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   Abstract 


Multiple primary malignancies in a single patient are exceedingly rare, but their prevalence has increased in recent decades due to prolonged survival rates supported by the advent of newer and better generation of chemotherapeutic agents as well as advances in cancer detectability facilitated by sophisticated modalities such as positron emission tomography-computed tomography. Here, we discuss a case of a 66-year-old male who recovered completely from lung carcinoma but subsequently developed synchronous gall bladder and gastric carcinoma after 1 year.

Keywords: Gall bladder, metachronous, positron emission tomography-computed tomography, stomach, synchronous


How to cite this article:
Tripathy S, Mirdha AR, Shamim SA, Parida GK, Subudhi K. A case of metachronous triple carcinoma with synchronous double primary carcinoma on18F-fluorodeoxyglucose positron emission tomography-computed tomography. Indian J Nucl Med 2020;35:174-5

How to cite this URL:
Tripathy S, Mirdha AR, Shamim SA, Parida GK, Subudhi K. A case of metachronous triple carcinoma with synchronous double primary carcinoma on18F-fluorodeoxyglucose positron emission tomography-computed tomography. Indian J Nucl Med [serial online] 2020 [cited 2020 Apr 7];35:174-5. Available from: http://www.ijnm.in/text.asp?2020/35/2/174/280448



A 66-year-old male was diagnosed with primary bronchogenic carcinoma (adenocarcinoma) in 2016 and underwent six cycles of chemotherapy (docetaxel and pemetrexed). He recovered completely and was symptom free for 1 year until 1 day when he experienced sudden excruciating abdominal pain and then developed jaundice after 15 days. Contrast-enhanced computed tomography (CT) abdomen was done which revealed a mass involving the body and neck of the gall bladder with adjacent infiltration of the liver parenchyma.18 F-fluorodeoxyglucose positron emission tomography-CT (18 F-FDG PET-CT) scan was done to rule out any distant metastases which revealed a polypoidal lesion (measuring ~ 4.0 cm × 2.1 cm) in the body of the stomach along the greater curvature showing intense FDG uptake in addition to the lesion in the gall bladder infiltrating the adjacent liver parenchyma [Figure 1]a, [Figure 1]b, [Figure 1]c, [Figure 1]d. Biopsy of the stomach lesion revealed a poorly differentiated adenocarcinoma, diffusely infiltrating into the lamina propria on hematoxylin and eosin stain [Figure 2]a and [Figure 2]b, which was immunopositive for CK7 [Figure 2]c whereas negative for CK20 [Figure 2]d, thyroid transcription factor 1, and napsin. These pathological findings were least suggestive of metastasis from the gall bladder or lung primary and more definitive of gastric adenocarcinoma. However, no other distant metastatic sites were documented on the PET-CT scan. Multiple primary malignancies are categorized into two types: (a) synchronous, i.e., having all malignant lesions at the same time or within 6 months of the first malignancy and (b) metachronous in which second or high-order malignancies occur at least 6 months after the last one.[1] The peculiarity of our case lies in the fact that the patient recovered from carcinoma lung but at the same time developed carcinoma gall bladder and stomach after around 1 year. Cancer survivors have a higher risk of new primary malignancy in same or different organ compared to the general population, and it can be therapy induced, syndrome related, or by sharing common etiologic factors.[2] Most of the reported literatures about synchronous primary belong to those with head and neck, aerodigestive tract, lung, ovary, and prostate primaries owing to the concept of “field cancerization.”[3] Most cases of the reported synchronous gall bladder and gastric primary belong to the Japanese literature; however, PET-CT was seldom used for its diagnosis.[4],[5],[6],[7] The utility of PET-CT using18 F as well as68 Ga labeled for the diagnosis of a second synchronous and metachronous primary in addition to a co-existent primary radiotracer has been highlighted in the literature by Chun-Sing et al. and Osman et al., respectively.[8],[9] PET-CT can clinch the diagnosis with better ease owing to its easier whole-body imaging property and can potentially change the management by avoiding unnecessary “upstage” of the primary malignancy. This case represents a rare scenario and highlights the role of FDG PET/CT in the detection of synchronous malignancies at a stage where both malignancies have not presented with distant metastasis, making treatment with curative intent still a viable option for this patient (thus the negative predictive value of PET/CT is also important in this case) with further emphasis on early follow-up.
Figure 1: (a) Maximum intensity projection image showing two focus-increased fluorodeoxyglucose uptake in the abdomen (b) Axial computed tomography image showing circumferential wall thickening in the gall bladder and polypoidal lesion in the body of the stomach along the greater curvature which shows increased fluorodeoxyglucose uptake on positron emission tomography (c) and fused axial positron emission tomography-computed tomography image (d)

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Figure 2: (a and b) Biopsy of the stomach lesion showing poorly differentiated adenocarcinoma, diffusely infiltrating into the lamina propria on hematoxylin and eosin stain, which was immunopositive for CK7 whereas (c) immunonegative for CK20, thyroid transcription factor 1, and napsin (d)

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Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Moertel CG. Multiple primary malignant neoplasms: Historical perspectives. Cancer 1977;40:1786-92.  Back to cited text no. 1
    
2.
Travis LB, Hill D, Dores GM, Gospodarowicz M, van Leeuwen FE, Holowaty E, et al. Cumulative absolute breast cancer risk for young women treated for Hodgkin lymphoma. J Natl Cancer Inst 2005;97:1428-37.  Back to cited text no. 2
    
3.
van Rees BP, Cleton-Jansen AM, Cense HA, Polak MM, Clement MJ, Drillenburg P, et al. Molecular evidence of field cancerization in a patient with 7 tumors of the aerodigestive tract. Hum Pathol 2000;31:269-71.  Back to cited text no. 3
    
4.
Tamura M, Shinagawa M, Funaki Y. Synchronous triple early cancers occurring in the stomach, colon and gallbladder. Asian J Surg 2003;26:46-8.  Back to cited text no. 4
    
5.
Kato M, Tsuji T, Sugiyama H, Kumahara T, Morishita H, Wakahara T, et al. Synchronous early double cancers of the stomach and gallbladder. Gan No Rinsho 1987;33:1095-100.  Back to cited text no. 5
    
6.
Tsutsui R, Kurihara N, Matsuura Y, Iida S. A case of an elderly patient who experienced long-term survival after receiving S-1 for synchronous advanced gallbladder and stomach cancer. Gan To Kagaku Ryoho 2017;44:79-81.  Back to cited text no. 6
    
7.
Oguri H, Urabe T, Yoneshima M, Inagaki Y, Kaneko S, Unoura M, et al. Acase of synchronous triple cancers of the stomach, common bile duct and multiple gallbladder cancers. Nihon Shokakibyo Gakkai Zasshi 1990;87:1888-92.  Back to cited text no. 7
    
8.
Chun-Sing W, Nan-Jie G, Yiu-Ching C. Prevalence of synchronous second primary malignancy: Identification using whole body PET/CT imaging. Clin Imaging 2014;38:179-86.  Back to cited text no. 8
    
9.
Osman MM, Iravani A, Hicks RJ, Hofman MS. Detection of synchronous primary malignancies with 68Ga-labeled prostate-specific membrane antigen PET/CT in patients with prostate cancer: Frequency in 764 patients. J Nucl Med 2017;58:1938-42.  Back to cited text no. 9
    


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