Aloraini AM, Helmi HA, Aljomah NA, Zubaidi AM. Multiple primary gastrointestinal tumors of gastric, pancreatic and rectal origin; a case report.
Int J Surg Case Rep 2021;
89:106610. [PMID:
34864258 PMCID:
PMC8645915 DOI:
10.1016/j.ijscr.2021.106610]
[Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 11/09/2021] [Accepted: 11/13/2021] [Indexed: 01/20/2023] Open
Abstract
Introduction
The occurrence of multiple primary synchronous or metachronous malignancies is a described phenomenon. Such cases may have genetic predisposition or could be related to environmental risk factors but may also be sporadic. We are reporting a unique combination of triple primary synchronous malignancies in the same patient.
Case presentation
A 71 year old man presented with constipation and per rectal bleeding with a palpable mass 5–6 cm from the anal verge on physical examination. Colonoscopy with biopsy confirmed adenocarcinoma of rectal origin. After multi-disciplinary tumor board meeting, the patient received neoadjuvant chemoradiation therapy followed by single-stage surgery. Re-staging work up showed the presence of pancreatic lesion. Incidental finding of a gastric nodule upon surgical exploration which was confirmed to be a gastrointestinal stromal tumor. The patient had an uneventful postoperative course.
Discussion
Multiple primary malignancies of the gastrointestinal system has previously been reported in the literature; whether in the form of double, triple, quadruple or even quintuple primaries. Furthermore, gastrointestinal malignancies have been reported to be combined with extra-intestinal malignancies. However, this unique combination of pancreatic adenocarcinoma, rectal adenocarcinoma and gastric gastrointestinal stromal tumor has not been previously reported in the literature. Single-stage multiple resections was successful.
Conclusion
We are reporting a unique case of three primary malignancies involving the rectum, pancreas and stomach. For such patients, there is no clear guidelines regarding management or surveillance, but rather should be individualized.
Multiple primary malignancies is becoming an increasingly common phenomenon.
We are reporting a case of multiple primary malignancies involving 3 organs successfully managed by single-stage surgery.
No guidelines exist for the management of such cases, although multi-disciplinary team approach is of value.
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