Synchronous double primary cancer - intrahepatic cholangiocarcinoma with bone metastases and thyroid carcinoma: A case report

Case report of multiple primary cancers and results of genetic testing to preliminarily explore their pathogenesis

The occurrence of multiple primary malignancies in a single patient has been relatively rare. We report here the case of a 71-year-old man with three primary tumors of lung cancer, intrahepatic cholangiocarcinoma, and prostate cancer, and a preliminary study of the mechanisms by which multiple primary tumors develop at the genetic level. Because of the late stage of the patient's condition, large tumor burden, and poor physical status, the patient survived only a few months. In the case presented herein, cholangiocarcinoma, lung cancer, and prostate cancer were found simultaneously, and the pathogenic sites are not related. Whole-exome sequencing was performed on the pathological tissues to explore the mechanism that may underlie multiple primary cancers at the genetic level. Several gene mutations were found in this case. They involved cell proliferation, cell cycle regulation, genetic stability, metabolism, cell invasion, angiogenesis, cell apoptosis, and other pathways. It can be preliminarily inferred that the mechanism underlying multiple primary tumors is related to the abnormality of tumor-promoting and suppressing pathways.

Diffuse bone metastasis from cholangiocarcinoma involving the sternum: A case report and review of literature

Cholangiocarcinoma (CCA) is a rare cancer of the bile duct epithelial cells and it commonly spreads to the regional lymph nodes, liver, and lungs. Bone metastasis has been reported in patients with CCA, involving both the axial and appendicular skeleton. Herein, we report a case of extrahepatic CCA with extensive bone metastases involving the calvarium, sternum, bilateral ribs and scapulae, entire spine, pelvis, and bilateral femur. To our knowledge, this is the first case report on sternum metastasis in CCA. The case presentation and review of literature highlighted the rarity of this metastasis, and health-care providers should be aware of the rare presentation of CCA.

Successful treatment of colorectal liver metastasis harboring intrahepatic cholangiocarcinoma: A case report

RATIONALE

Colorectal liver metastasis develops in 50% of patients diagnosed with colorectal cancer, whereas concurrent intrahepatic cholangiocarcinoma (ICC) and colorectal liver metastases is extremely rare.

PATIENT CONCERNS

A 72-year-old man was referred to our hospital complaining of abdominal discomfort, diarrhea, and weakness over the last month.

DIAGNOSES

Colorectal liver metastases concurrent intrahepatic cholangiocarcinoma (ICC).

INTERVENTIONS

The patient was treated with mFOLFOX6 (5-fluorouracil 2400 mg/m, leucovorin 400 mg/m, and oxaliplatin 85 mg/m) plus bevacizumab 5 mg/kg every 2 weeks for 2 months. However, chemotherapy was not effective for the liver S3 lesion in our case. The possibility of ICC was considered based on the multidisciplinary team (MDT) mode, together with an anomalous increase in cancer antigen 19-9 and a history of hepatolithiasis.

OUTCOMES

Simultaneous resection of the colon cancer and liver tumors was performed at 6 weeks after discontinuing bevacizumab. Colorectal liver metastases concurrent ICC was confirmed by postoperative pathology. The patient's disease-free survival time is currently >14 months.

LESSONS

This is the first case report of the diagnosis and timely treatment of colorectal liver metastases harboring ICC. These results suggest that multiple primary tumors should be considered as a differential diagnosis when imaging or laboratory test results are abnormal.

Intrahepatic cholangiocarcinoma coinciding with a liver metastasis from a rectal carcinoma: a case report

BACKGROUND

We experience many cases of liver metastasis from colorectal cancer, but synchronous occurrence of intrahepatic cholangiocarcinoma (ICC) and liver metastasis from a rectal cancer is extremely rare. We herein report a case of ICC coinciding with a liver metastasis from a known rectal carcinoma.

CASE PRESENTATION

A 68-year-old man was referred to our hospital for investigation of multiple liver tumors. Total colonoscopy and computed tomography (CT) revealed a rectal carcinoma, coinciding with liver metastasis. He was planned to receive chemotherapy following rectal resection. During chemotherapy for the rectal cancer, one of the liver tumors gradually grew after first shrinking. The following hepatectomy revealed the presence of intrahepatic cholangiocarcinoma (ICC). Despite intensive chemotherapy for the ICC, he passed away 6 months after the hepatectomy.

CONCLUSIONS

We should also suspect the possibility of multiple primary cancers, even if the patient has a history of cancer that is likely to cause metastatic lesions. When simultaneous neoplasms are diagnosed, systematic treatment should be targeted to the tumor with the worst prognosis.