Multiple primary cancers in extracolonic sites with colorectal cancer

Isolated liver gastrointestinal stromal tumor: A case report

Gastrointestinal stromal tumors (GISTs) originate from the gastrointestinal tract. GISTs originate outside the gastrointestinal tract, referred to as extra GISTs, which is rare. Primary liver gastrointestinal stromal tumor (PLGIST) and liver metastasis of gastrointestinal stromal tumor (LMGIST) may present isolated liver lesion, making it difficult to determine their origin. A 38-year-old man who presented with isolated multiple giant cystic-solid liver lesions, ultimately diagnosed as liver GIST through CT-guided fine-needle aspiration. However, distinguishing between PLGIST and LMGIST in this case is challenging due to the absence of detailed medical records of emergency small intestine resection 5 years ago. Over 2-year follow-up period, the maximum lesion size increased from 16 to 21 cm, still, no extra liver lesions were observed. This study aims to provide a review to enhance understanding of this rare liver entity, aiding in tumor diagnosis and staging.

Features of synchronous and metachronous dual primary gastric and colorectal cancer

BACKGROUND

Studies evaluating the characteristics of dual primary gastric and colorectal cancer (CRC) (DPGCC) are limited.

AIM

To analyze the clinicopathologic characteristics and prognosis of synchronous and metachronous cancers in patients with DPGCC.

METHODS

From October 2010 to August 2021, patients with DPGCC were retrospectively reviewed. The patients with DPGCC were divided into two groups (synchronous and metachronous). We compared the overall survival (OS) between the groups using Kaplan-Meier survival methods. Univariate and multivariate analyses were performed using Cox’s proportional hazards model to identify the independent prognostic factors for OS.

RESULTS

Of the 76 patients with DPGCC, 46 and 30 had synchronous and metachronous cancers, respectively. The proportion of unresectable CRC in patients with synchronous cancers was higher than that in patients with metachronous cancers (28.3% vs 3.3%, P = 0.015). The majority of the second primary cancers had occurred within 5 years. Kaplan-Meier survival analysis showed that the patients with metachronous cancers had a better prognosis than patients with synchronous cancers (P = 0.010). The patients who had undergone gastrectomy (P < 0.001) or CRC resection (P < 0.001) had a better prognosis than those who had not. In the multivariate analysis, synchronous cancer [hazard ratio (HR) = 6.8, 95% confidence interval (95%CI): 2.0-22.7, P = 0.002)] and stage III-IV gastric cancer (GC) [HR = 10.0, 95%CI: 3.4-29.5, P < 0.001)] were risk prognostic factor for OS, while patients who underwent gastrectomy was a protective prognostic factor for OS [HR = 0.2, 95%CI: 0.1-0.6, P = 0.002].

CONCLUSION

Regular surveillance for metachronous cancer is necessary during postoperative follow-up. Surgical resection is the mainstay of therapy to improve the prognosis of DPGCC. The prognosis appears to be influenced by the stage of GC rather than the stage of CRC. Patients with synchronous cancer have a worse prognosis, and its treatment strategy is worth further exploration.

Comprehensive next-generation sequencing reveals double primary colorectal carcinoma missed by diagnostic imaging: A case report

BACKGROUND

Multiple primary colorectal carcinoma (MPCC) is a rare clinical disease, which is challenging to differentiate from metastatic disease using histopathological methods. Next-generation sequencing (NGS) has been employed to identify multiple primary cancers.

CASE SUMMARY

This study a rare case of a 63-year-old male patient diagnosed with MPCC by targeted NGS, which was initially missed by radiological evaluation. The patient was found to have two tumors located on the surface of the colorectum which had distinct genomic alterations. Based on wild-type KRAS detected in the unresected tumor, the patient benefited from the epidermal growth factor receptor (EGFR) inhibitor cetuximab treatment, but developed novel mutations including KIF5B-RET fusion, which provides a possible resistance mechanism to anti-EGFR therapy.

CONCLUSION

Our case highlights the necessity of using genetic testing for primary tumor diagnosis and the application of serial plasma circulating tumor DNA profiling for dynamic disease monitoring.

Metachronous primary colon and periampullary duodenal cancer: A case report

RATIONALE

Primary periampullary duodenal cancer accounts for 3% to 17% of periampullary cancers. There are no previous reports of metachronous primary colon and periampullary duodenal cancer.

PATIENT CONCERNS

We present a case of primary periampullary duodenal cancer that occurred metachronously after colon cancer.

DIAGNOSES

Imaging and endoscopic examinations, serum tumor marker levels, and pathology confirmed metachronous colon and periampullary duodenal cancer, with 14-month interval between the diagnoses of the 2 malignancies.

INTERVENTION

The patient received right hemicolectomy combined with mFOLFOX6 chemotherapy for colon cancer and pancreatoduodenectomy for periampullary duodenal cancer.

OUTCOMES

The patient has been followed up for 6 years since the pancreatoduodenectomy and shows no signs of recurrence or metastasis.

LESSONS

The risk of developing a second malignancy may be associated with the site of the first tumor. Patients with right colon cancer may have particularly high risk of developing small intestinal cancer, including duodenal cancer. Early detection and active surgical treatments can improve prognosis. Long-term regular follow-up is necessary to detect new malignancies occurring after the diagnosis colon cancer.

Simultaneous Laparoscopy-Assisted Resection for Synchronous Colorectal and Gastric Cancer

Objectives The purpose of this study is to evaluate feasibility and safety of simultaneous laparoscopy-assisted resection for synchronous colorectal and gastric cancer. Methods From January 2001 to December 2013, a total of 29 patients underwent simultaneous resection for synchronous colorectal and gastric cancers. Medical records were reviewed, retrospectively. Results Eight patients (5 male) underwent laparoscopy-assisted resection (LAP group) and twenty one patients (17 male) underwent open surgery (Open group). In the both group, the mean age (65.2 vs. 63.7 years, p =0.481), body mass index (22.6 vs. 22.3, p = 0.896) was comparable, respectively. In LAP group, laparoscopy-assisted distal gastrectomy was performed for all eight patients. In Open group, subtotal gastrectomy with billroth I gastroduodenostomy was most common procedure (66.7%). The operation time, blood loss volume was similar between the two groups. Gas out was earlier (3.0 vs. 4.6 days p = 0.106), postoperative hospital stay was shorter (12.0 vs. 18.3 days, p = 0.245) in LAP group. The postoperative complications were an ileus, a wound seroma and a bile leakage in LAP group, pneumonia (10.0%), wound bleeding (5.0%) and leakage (5.0%) in Open group. Conclusions The simultaneous laparoscopy-assisted resection for synchronous colorectal cancer and gastric cancer is a feasible and safe procedure.

Synchronous mucinous colonic adenocarcinoma and multiple small intestinal adenocarcinomas: report of a case and review of literature

With the wide use of diagnostic imaging modalities, multiple primary malignancies frequently occur; different associations of malignancies have been reported. We describe the case of a primary mucinous adenocarcinoma of large bowel synchronous with three primary poorly differentiated adenocarcinomas of ileum. This type of association has not been described yet; since computed tomography increasingly is proving to be highly accurate in detection of colon cancer, this technique is recommended in such patients.

Multiple primary malignancies involving primary sporadic colorectal cancer in Japan: incidence of gastric cancer with colorectal cancer patients may be higher than previously recognized

BACKGROUND

Improvement in the prognosis of colorectal cancer (CRC) patients has led to increasing occurrences of multiple primary malignancies (MPMs) alongside CRC but little is known about their characteristics. This study was undertaken to clarify the clinical and pathological features of MPMs, especially those at extra colonic sites, in patients with CRC.

METHODS

We reviewed 1,111 patients who underwent operations for primary sporadic CRC in Saitama Medical Center, Jichi Medical University between April 2007 and March 2012. Two patients with familial adenomatous polyposis, one with hereditary non-polyposis colorectal cancer, two with colitic cancer, and any patients with metastasis from CRC were excluded. We compared the clinicopathological features of CRC patients with and without MPMs. As a control, we used a database compiled of patients with gastric cancer (GC) detected by mass screening performed in the Saitama Prefecture in Japan 2010 and compared these with CRC patients with synchronous GC.

RESULTS

Multiple primary malignancies at extracolonic sites were identified in 117 of 1,111 CRC patients (10.5%). The median age was 68 (range, 29 to 96) versus 71 (50 to 92) (P < 0.001). The incidence of GC (44.4% (52 of 117)) was the highest of all MPMs. All CRC patients with GC were older than 57 years. Synchronous GC was detected in 26 patients. By contrast, out of 200,007 screened people, 225 people were diagnosed as having GC in the Saitama Prefecture. The age-standardized incidence of synchronous GC in CRC patients was significantly higher (0.53%) than in the control group (0.03%) (odds ratio, 18.8; 95% confidence interval, 18.6 to 19.0; P < 0.001).

CONCLUSION

Patients with CRC who were older than 50 years preferentially developed GC synchronously and metachronously. Thus, this patient group should undergo careful perioperative screening for GC.

[Clinicopathologic features of colorectal cancer combined with synchronous and metachronous gastric cancer]

BACKGROUND/AIMS

The purpose of this study was to investigate the clinicopathologic features of double primary cancers of the stomach and colorectum, compared to colorectal cancer alone.

METHODS

A retrospective analysis was made of 5,288 patients who underwent colorectal cancer surgery between January 2000 and December 2009 at Severance Hospital of Yonsei University. The clinicopathologic features were analyzed between 63 patients of double primary cancers and case-matched 126 patients of colorectal cancer alone. We classified double primary cancers into subgroups as premetachronous, synchronous and postmetachronous gastric cancer to identify differences between the three subgroups also.

RESULTS

Double primary cancers group showed 4.3 year-older age, lower BMI, and higher percentage of peritoneal metastasis, compared to colorectal cancer alone group. Overall and colorectal cancer specific survival did not have any significant difference between two groups. In histologic type of gastric cancer, a high percentage of undifferentiated adenocarcinoma (55.6%) and signet ring cell carcinoma (30.2%) were noted.

CONCLUSIONS

Double primary cancers of the stomach and colorectum had older-age onset, lower BMI and higher metastasis to peritoneum than colorectal cancer alone. Combined gastric cancer consisted of high percentage of undifferentiated and signet ring cell carcinomas.

BRAF mutation in multiple primary cancer with colorectal cancer and stomach cancer

Aims: Recently, BRAF mutation testing has been introduced as a marker in differentiating Lynch syndrome from sporadic colorectal cancers or in predicting colorectal cancers with worse prognosis. Individuals with hereditary predisposition to cancer development are at an increased risk of developing multiple primary cancers. The purpose of this study is to identify mutation in the BRAF gene in multiple primary cancers with colorectal cancer and stomach cancer.

Methods: BRAF mutation was analysed in 45 patients with colorectal cancer and stomach cancer, synchronously or metachronously.

Results: Mean age was 64.07 years (range: 47–83 years). For the colorectal cancer, tumors were located at the sigmoid colon in eight patients (17.8%) and at the rectum in 22 patients (48.9%). Twenty-three patients (51.1%) had synchronous cancer. Four patients (8.9%) had family members with cancer. BRAF mutation was identified in three patients (6.7%). All three of these patients had metachronous cancers. The colorectal cancers were located in the sigmoid colon (1 patient) and the rectum (2 patients).

Conclusions: BRAF mutation rate was low in the multiple primary cancer with colorectal cancer and stomach cancer. With only BRAF gene study, it was not possible to identify any correlation with family history of colorectal cancer. Further study means considering other genes – MSI, MSH2, MLH1, MSH6.

Clinicopathologic characteristics of colorectal cancer patients with synchronous and metachronous gastric cancer

BACKGROUND

We investigated the characteristics of synchronous and metachronous gastric cancer in patients with colorectal cancer.

METHODS

We reviewed 8,680 patients who underwent operations for primary sporadic colorectal cancer from 1989 to 2008. Synchronous gastric cancer was defined as gastric cancer diagnosed within 6 months of a colorectal cancer diagnosis. Gastric cancer diagnosed more than 6 months before or after colorectal cancer was defined as metachronous.

RESULTS

The incidences of synchronous and metachronous gastric cancer were 0.93 and 1.4%, respectively (combined 2.4%). The standardized incidence ratio was 1.199 (95% confidence interval [CI] = 1.005-1.420) when the patients with premetachronous gastric cancer were excluded. Patients with synchronous and metachronous gastric cancer were 5 years older on average compared to the control population without gastric cancer. In addition, multivariate analysis revealed an odds ratio (OR) of 3.6 for being male, OR = 2 for positive family history of solid tumors, OR = 2.2 for colonic lesion, and OR = 4 for MSH2 expression loss compared to patients without gastric cancer. Patients with postmetachronous gastric cancer (when compared to synchronous and premetachronous gastric cancer), a preoperative CEA level of less than 6 ng/ml, and a relatively early stage of colorectal cancer had significantly higher overall (p = 0.016, 0.007, and 0.004, respectively) and disease-free survival rates (p = 0.046, 0.003, and 0.004, respectively), only on univariate analysis. Lymphovascular invasion of colorectal cancer and an advanced stage of gastric cancer were independent poor prognostic factors for both overall (p = 0.018) and disease-free survival (p = 0.028).

CONCLUSIONS

Gastric cancer surveillance is recommended for patients with colorectal cancer, especially when the patient is old and male, has a positive family history of solid tumors, has a colonic lesion, or lacks MSH2 expression.