Multiple primary gastrointestinal tumors of gastric, pancreatic and rectal origin; a case report

Presentation of Gastrointestinal Stromal Tumor, Pancreatic Adenocarcinoma, and Gastric Adenocarcinoma in a Woman With No Identifiable Genetic Abnormalities

This report details the first known case of co-occurrence of gastrointestinal stromal tumor (GIST), pancreatic adenocarcinoma, and gastric adenocarcinoma in an individual with no identifiable genetic abnormalities. The patient is a 57-year-old female who presented with abdominal pain. CT scan demonstrated a pancreatic mass, and endoscopic ultrasound demonstrated an additional gastric mass. Biopsy of both masses demonstrated adenocarcinoma; however, the masses were found to have different origins. The patient underwent neoadjuvant chemotherapy with excellent response. She then underwent surgical intervention, which demonstrated no ongoing adenocarcinoma in either location, and demonstrated a small focus of GIST. Genetic testing demonstrated no identifiable abnormalities. The presence of 3 primary neoplasms in an individual with no known genetic mutations represents a novel case study. These findings may suggest that screening for additional primary neoplasms may be indicated, even in patients for whom metastatic disease is initially suspected.

Synchronous Pancreatic Ductal Adenocarcinoma in the Head and Tail, a Double Trouble: A Case Report and Literature Review

Synchronous primary pancreatic ductal adenocarcinoma (PDAC) is very rare and can be formed either through multicentric carcinogenesis or intrapancreatic metastasis. We report the case of an 80-year-old man with a history of type 2 diabetes mellitus who presented with abdominal pain and weight loss. Laboratory tests showed elevated levels of blood glucose and CA 19-9, and Computed Tomography revealed two hypoenhancing lesions in the head and tail of the pancreas. Endoscopic ultrasound, which is the imaging method of choice for pancreatic cancer, was performed with a fine needle biopsy, and the cytological analysis diagnosed PDAC in both lesions. The patient underwent total pancreatectomy, and pathologic evaluation revealed synchronous primary PDAC with moderate to poor differentiation in the head and tail in the setting of IPMN (intraductal papillary mucinous neoplasia) and chronic pancreatitis. After his recovery from postoperative pulmonary embolism, the patient was discharged home with sufficient glycemic control. Multifocal PDAC occurs more often when precursor lesions, such as IPMN, pre-exist. The optimal treatment for multiple lesions spread all over the pancreas is total pancreatectomy. Diabetes mellitus is a serious complication of total pancreatectomy (new-onset or type 3c), but overall, long-term survival has been significantly improved.