Arquivos de Oncologia Cirúrgica

Introduction: The incidence of multiple primary malignant neoplasms (MPMN) increases with age. While they are nowadays encountered more frequently, the phenomenon is still considered to be rare. Our case represent a rare association between breast and rectal cancer. Multiplicity of primary malignancies itself does not necessarily indicate a poor prognosis as long as adequate diagnosis and management are performed.
Case presentation: We report a case of a Moroccan female, aged 46 years old, who was diagnosed with both a breast cancer metachronous and rectal adenocarcinoma within an eleven years period. The literature on multiple primary malignancies in a single patient is reviewed and the data are summarized.
Conclusion: From this rare case report and a review of the literature, it would appear that individuals who developed one malignancy might be at greater risk of developing a second. The occurrence of multiple primary malignant neoplasms in our case may be explained by microsatellite instability, and increased surveillance. But there is no genetic predisposition.

Extragonadal malignant transformation of a teratoma is rare, with only six reported cases in the literature. We report a case of a 33-year-old gravida 4 para 2 woman who had incidentally discovered bilateral pelvic masses, which were followed radiographically for nine years. She then underwent surgical resection, which revealed metastatic trabecular carcinoid involving lymph node tissue (left retroperitoneal pelvic mass), and trabecular carcinoid arising in a background of mature teratoma (right presacral mass). This case illustrates the indolent nature of this tumor and the importance of complete surgical resection.

Tuberculosis is endemic in Bangladesh. It remains a resilient public health concern. Reports on presentation and management of intracranial tuberculoma from Bangladesh are sparse. Despite being potentially remediable, tuberculomas are still a cause of significant morbidity and mortality in developing nations. Intracranial tuberculomas can occur as solitary or multiple lesions. Multiple isolated intracranial tuberculomas are rare, and difficult to discern from brain metastases. A unique case of intracranial tuberculomas is presented, which masqueraded as brain metastases on imaging studies and was diagnosed and treated with a trial of antitubercular chemotherapy. A 43-year-old Bengali male presented to the OPD with headaches and blurring of vision for four months. He was provided symptomatic treatment at his regional hospital, which did not abate his condition and was later referred to our center when he developed severe vomiting. Routine investigations including chest radiograph were clean. CT scan showed bilateral edema in cerebral hemispheres and MRI revealed rounded signal change areas of right frontal lobe and left parietal lobe posteriorly, strongly suggestive of brain metastases. Patient declined biopsy. In view of his past history, a full course of antitubercular chemotherapy was prescribed. Following the medication, patient’s condition improved and at 24 months follow-up, there was complete resolution of the lesion.

Purpose: In adolescents, carcinomas are rare tumors, accounting for 15% to 20% of cancers, with a wide spectrum.
Methods: Report of clinical, pathological and genetic characteristics of patients aged 12 to 18 years treated at Gustave Roussy for a carcinoma from 1990 to 2009.
Results: 204 adolescents, sex ratio F/M: 140/64, median age 16 years, were identified. Main sites were thyroid (40%, with 67/82 papillary carcinomas) and nasopharynx (20%). Five-year OS and EFS of the whole cohort were respectively 75% (95%CI 0.68-0.80) and 64% (95%CI 0.57-0.71). We identified three risk groups: (1) thyroid and salivary gland carcinomas (5-y OS 100%), (2) nasopharyngeal undifferentiated carcinomas and genital carcinomas (5-y OS 80%), (3) others such as hepatocellular carcinomas, renal carcinomas and squamous cell carcinomas of the oral cavity (5-y OS 24%). A genetic predisposition to cancer was identified in only 9/204 adolescents.
Conclusion: Thyroid and nasopharyngeal carcinomas are the most frequent sites and carry a good prognosis whereas squamous cell carcinomas of the oral cavity, hepatocellular carcinomas and non-localized renal carcinomas mostly portend a fatal outcome. International collaborative research between pediatric and medical oncologists is needed to improve the prognosis and to better understand the genetic determinants of these tumors with an unusual onset during adolescence.