Synchronous triple cancers at middle and lower esophagus and stomach with different histological features and genetic alterations

Abstract

Synchronous multiple primary malignancies are relatively unusual. We describe a case of synchronous triple cancers located at the middle and lower esophagus and the stomach in a 59-year-old Taiwanese man who presented with progressive dysphagia, epigastralgia, and bodyweight loss in 1 month. Endoscopic and histological features, microsatellite instability status of genomic DNA, and immunohistochemical staining of p53, MUC2, Fhit, c-erbB-2 and E-cadherin of all three cancers were demonstrated. We noted that these three cancers arose from different clones and that p53 mutation, instead of microsatellite instability, may play a major role in the development of multiple primary malignancies in this patient.

Clinical presentation, endoscopic features, treatment and prognosis of synchronous upper gastrointestinal malignancies

“…According to the prior studies, 4,7,12,13,17,18 the synchronous occurrence of upper GI cancer in not only esophageal and gastric cancer, but also duodenal and gastric cancer, is not rare. Therefore, endoscopists should keep in mind the possibility of multiple primary cancers occurrence during the preoperative examination.…”

Synchronous triple squamous cell carcinoma of the esophagus

“…However multiple SCC in the esophagus is a extremely rare event. The literature has shown only five double SCC and none with higher number of tumors [ 2 , 4 , 5 , 10 , 12 ]. This is the first published triple SCC only in the esophagus.…”

“…Reports of multiple synchronous cancers have been increasing due to prolonged lifespan and improvements in diagnostic techniques [ 1 ] range from 5% to 20% in the literature [ 1 , 2 , [4] , [5] , [6] , [7] , [8] , [9] , [10] , [11] , [12] , [13] , [14] ]. The most well known is with head and neck and lung similar cancers [ 1 , 2 , 4 , 11 , 14 , 15 ]. The association between different SCC can be explained from exposure to common carcinogenic agents such as tobacco smoke and alcoholism [ [4] , [5] , [6] , 11 ].…”

“…Synchronous multiple cancers in the same organ are well known in colon, stomach and thyroid, but is extremely rare in esophagus. The literature registered only five cases of synchronous and metachronous double SCC of the esophagus [ 2 , 4 , 5 , 10 , 12 ] work has been reported in line with the SCARE criteria.…”

Triple synchronous cancers: a medical and ethical problem

“…There are interesting site combinations of triple cancers. The most frequently reported were all tumours in the same organ or organ system: lung, 3-9 digestive organs, [10][11][12][13] and urogenital organs. [14][15][16][17][18][19] Lung cancer appeared in combination with tumours of two various organs: urinary bladder and esophagus, 20 breast and stomach, 21 pancreas and duodenum, 22 and stomach and thyroid.…”