Download Multiple primary malignant tumors M P M T

Multiple primary malignant
tumors
MPMT
MPMT
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
MPMT
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 0.99%
(152/15398): 51 cases were
synchronous MPMTs, and 101
cases were metachronous
MPMTs.
MPMTs were observed more
frequently in :
Head and neck tumors (5.65%)
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
CASE ‫معرفی‬
Triple primary metachronous
cancers in one patient
‫بیمار آقایی ‪ 77‬ساله است‬
‫درسال ‪( 1374‬درسن ‪ 57‬سالگی ) 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.G‬قرار گرفته‬
‫وتا چندین سال مورد فالو آپ توسط‬
‫همکارا ن ارولوژیست بوده است‪.‬‬
‫‪‬دراردیبهشت سال ‪ 1388‬بیمار 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 ‪ 1389‬با تابلوی ‪Rectal‬‬
‫‪ bleeding‬مورد کولونوسکوپی و بیوپسی‬
‫از ‪ Recto sigmoid‬قرار گرفت ‪.‬‬
‫‪‬در تاریخ دی ماه ‪ 1389‬با تشخیص‬
‫ادنوکارسینوم ‪ Recto sigmoid‬تحت عمل‬
‫جراحی قرار میگیرد‪.‬‬
‫گزارش پاتولوژی‬:
-Well differentiated
adenocarcinoma
-Both surgical margins are free.
-Tumoral cells extended to full
wall thickness of intestine.
T3 Nx M0
: adjuvant ‫درمانهای‬
-Concurrent chemoradiation
therapy :
Whole pelvis radiation ( 5040
cGray / 28 factions )
with Capcitabin (oral)
-Chemotherapy with FOLFOX
protocol
‫در سال ‪ 1391‬با توجه به هماچوری و عود‬
‫تومور مثانه مجددا ‪ TUR-B‬انجام شد ‪.‬‬
‫گزارش پاتولوژی دقیقا مشابه همان گزارش قبلی‬
‫بود‪ TCC ( .‬مثانه ‪ ,‬بدون درگیری الیه عضالنی‬
‫و ‪) low grade‬‬
‫ در سال ‪ 1393‬عود مجدد تومور مثانه‬‫ ‪TUR-B‬‬‫‪ -‬درمان اینتراوزیکال با داروی ‪Mitomycin‬‬
‫اسفند ‪: 1393‬‬
‫در ‪ CT-Scan‬ضایعات تومورال متعدد پولیپی داخل‬
‫مثانه (عود وسیع تومور مثانه) ‪,‬بافت های ‪peri‬‬
‫‪ vesical‬سالم 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.