Abstract. Synchronous multiple primary cancers are relatively uncommon and synchronous multiple cancers in coexistence with dermatomyositis (DM) are extremely rare. In the present study, we report a case of a 64-year-old male with nasopharyngeal undifferentiated non-keratinizing carcinoma and cardia adenocarcinoma which were diagnosed synchronously. In addition, suspected DM was diagnosed during the course of chemotherapy. The symptoms of DM were exaggerated even when methylprednisolone while administered. The patient succumbed to nutritional deterioration four months following his initial admission. In the present study, the etiologies of multiple primary cancers are discussed and a brief review of the literature on the correlation between malignance and DM was conducted.
IntroductionMultiple primary cancers are relatively uncommon. The present study reports a case in which synchronous nasopharyngeal undifferentiated non-keratinizing carcinoma and cardia adenocarcinoma were diagnosed. During the therapy course, progressive painless symmetric proximal muscle weakness and a skin rash emerged and were accompanied with dysphasia. In addition, suspected dermatomyositis (DM) was diagnosed. DM developed progressively in spite of application of methylprednisolone until the patient succumbed to nutritional deterioration on May 6, 2012. We present this case with two noteworthy aspects. Firstly, synchronous nasopharyngeal undifferentiated non-keratinizing carcinoma and cardia adenocarcinoma are relatively uncommon; and secondly the coexistance of multiple primary cancers with DM is extremely rare and indicative of poor prognosis.
Case reportsClinical presentation. The patient was a 64-year-old male from Sichuan, China. Prior to admittance in January 2012, the patient had experienced tinnitus of the right ear for one year and bloody nasal mucus for two months. A tumor was identified on the right and top wall of the nasopharynx by magnetic resonance imaging (MRI) and nasopharyngeal mirror. MRI also revealed that the right pharynx was absent and the right base of the skull had been destroyed by the tumor. Pathological results of the tumor confirmed that it was nasopharyngeal undifferentiated non-keratinizing carcinoma. Two hard lymph nodes in the right neck, with an approximate diameter of 2 cm, were identified by physical examination. Comprehensive examination of the patient was performed. Abdominal computer tomography (CT) revealed multiple nodules in the liver, indicative of metastasized lesions. The diameter of these nodules ranged between 2 and 3 cm. In addition, CT revealed a thicker than normal cardia tube wall. Gastroscopy was performed and a large neoplasm was identified surrounding almost the entire diameter of the cardia (Fig. 1). Pathological analyses were consistent with the diagnosis of cardia adenocarcinoma. In situ Epstein-Barr virus (EBV)-encoded small RNA (EBER) detection demonstrated that the nasopharyngeal carcinoma cells were positive and cardia carcinoma cells were negative for EBER (Fig. 2). The study ...