Multiple primary malignant tumors M P M T

M P M T Multiple primary cancers are defined as occurrence of two or more malignancies, synchronous or metachronous, in different organs without any relation to each other

metachronous M P M T synchronous

synchronous M P MT The term “synchronous” is used when the second primary cancer is diagnosed within 6 months of the primary cancer

metachronous M P M T “metachronous” is used when the second primary cancer is diagnosed more than 6 months after the diagnosis of the primary cancer. 

Occurrence of multiple primary malignancies is still very rare

Prevalence of multiple primary malignancies is slowly increasing due to prolonged survival of cancer patients with advances in diagnostic and therapeutic modalities

The reasons may be environmental modifications, genetic predisposition or therapy induced. 

According to the surveillance, epidemiology, and end results; cancer registries of the National Cancer Institute and cancer survivors had a 14% higher risk of developing a new malignancy than would have been expected in the general population.

Females had a slightly higher relative risk than males for all subsequent cancers combined, and the most implicated sites were breast, colon, lung, and melanoma of the skin (Curtis et al., 2006).

The prevalence of MPMTs in one study was 0 The prevalence of MPMTs in one study was 0.99% (152/15398): 51 cases were synchronous MPMTs, and 101 cases were metachronous MPMTs. 

MPMTs were observed more frequently in : Head and neck tumors (5 MPMTs were observed more frequently in : Head and neck tumors (5.65%) Urinary tumors (4.19%). 

Despite its low incidence, the association of two malignancies in a single patient has been widely reported in the literature, while only a few cases of three malignancies have been described

Triple primary metachronous cancers in one patient CASE معرفی Triple primary metachronous cancers in one patient

بیمار آقایی 77 ساله است درسال 1374 (درسن 57 سالگی ) بعلت هماچوری تحت ترانس یورترال رزکشن قرار می گیرد . گزارش پاتولوژی : Papillary transitional Cell carcinoma low grade without muscular layer invasion.

سپس بیمار تحت درمان اینتراوزیکال با داروی B. C سپس بیمار تحت درمان اینتراوزیکال با داروی B.C.G قرار گرفته وتا چندین سال مورد فالو آپ توسط همکارا ن ارولوژیست بوده است.

دراردیبهشت سال 1388 بیمار با تشخیص تومورکلیه ی چپ مورد عمل جراحی رادیکال نفرکتمی قرار میگیرد.

گزارش پاتولوژی : -Renal cell carcinoma, clear cell type (histologic grade) : G2 -The tumor’s largest diameter is 4 cm -Renal vein & Ureter are free of tumor. -No capsular invasion is identified. -The Adrenal is free of tumor. -No Perinephric fat invasion is identified.

در اواخر سال 1389 با تابلوی Rectal bleeding مورد کولونوسکوپی و بیوپسی از Recto sigmoid قرار گرفت .

گزارش پاتولوژی : -Well differentiated adenocarcinoma -Both surgical margins are free. -Tumoral cells extended to full wall thickness of intestine. T3 Nx M0

درمانهای adjuvant : -Concurrent chemoradiation therapy : Whole pelvis radiation ( 5040 cGray / 28 factions ) with Capcitabin (oral) -Chemotherapy with FOLFOX protocol

در سال 1391 با توجه به هماچوری و عود تومور مثانه مجددا TUR-B انجام شد در سال 1391 با توجه به هماچوری و عود تومور مثانه مجددا TUR-B انجام شد . گزارش پاتولوژی دقیقا مشابه همان گزارش قبلی بود. (TCC مثانه , بدون درگیری لایه عضلانی و low grade )

- در سال 1393 عود مجدد تومور مثانه - TUR-B - درمان اینتراوزیکال با داروی Mitomycin

عمل جراحی radical cystectomy اسفند 1393 : در CT-Scan ضایعات تومورال متعدد پولیپی داخل مثانه (عود وسیع تومور مثانه) ,بافت های peri vesical سالم بود. عمل جراحی radical cystectomy

گزارش پاتولوژی رادیکال سیستکتومی : -Multifocal papillary transitional ( Urothelial ) cell carcinoma ,low grade , superimposed by high grade transformation ( multifocal ). -Lamina propria show chronic cystitis without tumoral invasion. -Muscularis layer and lymphovascular invasion are not identified. -Prostate and its adnexa are free from tumoral invasion.