Indian Journal of Nuclear Medicine

INTERESTING IMAGE
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


Sarthak Tripathy1, Asit Ranjan Mirdha2, Shamim Ahmed Shamim1, Girish Kumar Parida1, Kishan Subudhi1,  
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

Correspondence Address:
Dr. Shamim Ahmed Shamim
Room No. 4, Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi - 110 029
India

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.



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;35:174-175


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 2022 Aug 10 ];35:174-175
Available from: https://www.ijnm.in/text.asp?2020/35/2/174/280448


Full Text



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}{Figure 2}

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Conflicts of interest

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