Triple primary malignancies in a patient with colorectal adenocarcinoma: A case report

Our plain-English summary of Triple primary malignancies in a patient with colorectal adenocarcinoma: A case report, by Q. Huang, X. He, H. Qin, et al (International Journal of Surgery Case Reports, 2018).

The study

• Authors: Q. Huang, X. He, H. Qin, X. Fan, M. Xie, L. Lian
• Journal: International Journal of Surgery Case Reports
• Published: 2018;42:34-37
• Cited by: 3 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Introduction: While colorectal carcinoma is one of the most commonly diagnosed malignancies, its synchronous occurrence with other primary malignancies is rare.

Presentation Of Case: In this case, we describe the diagnosis and surgical intervention of a 55-year-old male patient who was found to have colonic adenocarcinoma at the hepatic flexure, right renal urothelial carcinoma, and malignant mesothelioma.

Discussion: None of the previous studies reported these three distinct types of cancer, even in those patients with Lynch Syndrome. To the best of our knowledge, this is the first report of such case. The etiology and pathogenesis of multiple primary malignancies are complex. Common genetic and environmental risk factors that were found in different cancers might increase the risk of multiple primary malignancies.

Conclusion: The use of genetic testing and preoperative imaging studies should be considered to be invaluable tools for detecting synchronous malignancies. Practicing physicians should pay more attention to the risk of simultaneous separate primary malignancies.

Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.

In plain English

This was a case report about one 55-year-old man who had two months of on-and-off pain in the right upper abdomen with liquid stools, and had lost 5 kg. He had no family history of colorectal cancer. Colonoscopy and biopsy found adenocarcinoma of the colon at the hepatic flexure. In surgery, the right colon and right kidney were removed, along with a 5 by 5 cm nodule behind the colon that had grown into the right ureter, the duodenum, the inferior vena cava and the lumbar vertebra. Tissue examination showed three separate cancers. The first was the colon adenocarcinoma, with none of 54 lymph nodes involved. The second was a non-invasive, low-grade urothelial carcinoma. The third was malignant mesothelioma, found in the duodenal tissue and in tissue in front of the inferior vena cava. The article did not mention asbestos. The colon tumor was negative for MSH2, which the authors said suggested Lynch syndrome. The patient recovered and received chemotherapy for liver metastasis. The authors stated that, to their knowledge, this was the first report of this combination. They concluded that physicians should pay more attention to the risk of simultaneous separate primary cancers.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: case report (single patient)
• Who was studied: One 55-year-old man with abdominal pain, liquid stools and weight loss, and no family history of colorectal cancer
• Exposure: The article does not report any asbestos exposure, fiber type or occupational history for the patient
• Main results:
  • A 5 by 5 cm solid nodule behind the ascending colon had invaded the right ureter, the second portion of the duodenum, the inferior vena cava and the lumbar vertebra
  • Tissue removed from in front of the inferior vena cava and from the involved duodenal segment was shown to be malignant mesothelioma
  • The ureter and adjacent tissue showed a non-invasive low-grade urothelial carcinoma
  • In the colon adenocarcinoma, none of the 54 lymph nodes examined showed metastasis (staged T4bN0M1)
  • MSH2 was negative, which the authors said was suggestive of Lynch syndrome
  • Genetic testing found a KRAS gene mutation; NRAS, BRAF and PIK3CA genes were wild type
  • The patient recovered without complications after surgery and received regular chemotherapy for liver metastasis
• The authors' conclusion: The authors believed this was the first reported case of these three cancers together. They concluded that physicians caring for colorectal cancer patients should pay more attention to the risk of simultaneous separate primary malignancies.

Topics

Medical terms in this study, explained in our Lexicon: Adenocarcinoma, Carcinoma, Mesothelioma, Etiology.

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