NAHEED SHAKOOR , DILWASH BALOCH , SAIMA ZAHOOR , GULHAM HAIDER , AQSA
BACKGROUND
Prevalence of multiple primary malignancies is progressively increasing, largely due to prolonged survival of cancer patients with advances in diagnostic and therapeutic modalities. Contributing factors may be environmental modifications, genetic predisposition or therapy induced. We report the case of a middle age woman with three different synchronous primary malignancies managed at our center over a oneyear period. Literature has well-documented endometrial Cancer with pulmonary metastases, the coexistence of synchronous endometrial adenocarcinoma with primary lung adenocarcinoma and meningioma is rarely been reported.
OBJECTIVES
To emphasize the importance of maintaining a high index of suspicion for multiple primary malignancies (MPM) in patients presenting with new symptoms and need for management strategies in the absence of standard guidelines
CASE PRESENTATION
A 59-year-old female with a 15-year history of diabetes mellitus and hypertension presented at our OPD with a one-year history of postmenopausal bleeding. Transvaginal ultrasonography revealed an endometrial mass, and subsequent histopathological (fig.01) evaluation confirmed the diagnosis of endometrioid adenocarcinoma. While undergoing preoperative workup for planned gynecologic surgery, a routine chest X-ray incidentally detected a suspicious lesion in the right lung. Contrast-enhanced computed tomography of the chest identified a mass in the middle lobe, which was confirmed by biopsy to be primary pulmonary adenocarcinoma. Given this unexpected finding, the surgical plan was deferred, and immunohistochemical profiling was pursued. The tumor tested negative for EGFR mutations and PD-L1 expression. Consequently, the patient was initiated on a chemotherapy regimen of Paclitaxel (60 mg/m²) and Carboplatin (AUC 2), previously intended for the gynecologic malignancy.
Two months into treatment, the patient developed newonset headaches. Contrast-enhanced magnetic resonance imaging of the brain revealed an extra-axial lesion consistent with a meningioma. As the patient remained neurologically intact and imaging showed no signs of progression, she was continued on the existing chemotherapy protocol with regular MRI surveillance. follow-up evaluations demonstrated stable disease across all three sites endometrial adenocarcinoma, pulmonary adenocarcinoma, and meningioma suggesting disease control under the current chemotherapeutic regimen.
DISCUSSION
This is a case of synchronous MPM, patient presented with endometrial and lung adenocarcinoma, and a meningioma. Positivity of highly specific markers; Napsin A and thyroid transcription factor-1 (TTF-1) distinguished the primary lung adenocarcinoma from metastatic lung tumors. In addition, CT-SCAN abdomen was done to rule out any primary gastroenterological metastasis. However, development of another primary malignancy after successful management of previous one should be always kept in mind while managing patients of malignancies. Clinician should either opt for radical therapy or palliative treatment as like this patient .
CONCLUSION
Awareness and suspicion of multiple primary malignancy and aggressive diagnostic work up play crucial role in their detection at earlier stage for better outcome. In addition, choice of appropriate chemotherapeutic agents and their regimens remain the cornerstone while managing the patients with multiple primary malignancies.
REFERENCES
1.Copur, M. S., & Manapuram, S. (2019). Multiple primary tumors over a lifetime. Oncology (Williston Park, N.Y.), 33(7) https://www.cancernetwork.com/view/multiple-primary-tumorsover-lifetime