Post on 07-Apr-2018
Title: Case reports of multiple synchronous tumors after breast chemotherapy
Mehmet VELIDEDEOGLU1, Fahrettin KILIC2, Yasemin KUCUK1, Akif Enes ARIKAN1,
Abdullah TUTEN3, M. Halit YILMAZ2, Varol CELIK1, Ertugrul GAZIOGLU1, Mehmet
FERAHMAN1
1Istanbul University, Cerrahpasa Medical Faculty, Department of General Surgery, Istanbul,
Turkey
2Istanbul University, Cerrahpasa Medical Faculty, Department of Radiology, Istanbul, Turkey
3Istanbul University, Cerrahpasa Medical Faculty, Department of Gynecology and Obstetrics,
Istanbul, Turkey
Introduction
Multiple primary malignant tumors can be defined as more than two different tumors,
located in the same organ or different organs. As well as, three different concurrent primary
malignancies are extremely rare conditions. We present a case with both invasive ductal
carcinoma of the breast, neuroendocrine tumor of the other breast and mucinous adenocarcinoma
of the colon.
Case 1
A 52 year-old woman with history of left modified radical mastectomy and adjuvant
chemotherapy for invasive ductal carcinoma admitted with right mastalgia. No lesion was
detected in physical examination. Ultrasonography (US) showed a 20*15 mm mass in the upper
outer quadrant of the breast .She received invasive ductal carcinoma by an US-guided core
biopsy. Full body positron emission tomography (PET CT) with 10 mCi F-18 fludeoxyglucose
(FDG) showed an increase metabolic activity at same localization in breast site, and transverse
colon. On colonoscopy, ~6*5 cm long mass was found on transvers colon, the lesion was
diagnosed as epithelial high grade neoplasia with punch biopsies.
The patient underwent right partial mastectomy and axillary dissection, as sentinel lymph node
biopsy was positive. Transverse colon resection and omentectomy was planned as another
session. Pathological examination of the mastectomy revealed a 2 cm good differentiated
neuroendocrine tumor with histological grade 2, and 2/14 axillary lymph nodes was positive as
micrometastases. Synaptophysin was positive and chromogranin focal positive. Hormonal
receptors were strongly positive and Cerb-B2 was negative with %30 Ki-67 score. Pathological
examination of transverse colon, mucinous adenocarcinoma was determined as a third different
cancer focus.
Case 2
During follow-ups, of an 80 year-old woman with a history of right breast conserving surgery
and right axillary dissection 9 years ago with adjuvant chemotherapy, mammography and
ultrasonography showed a 10*18 mm mass in in upper outer quadrant of the left breast. US-
guided core biopsy of the lesion revealed invasive lobular carcinoma. FDG PET/CT revealed
lesions with increased uptake in upper quadrant of the left breast and rectal colon segment.
Colonoscopic punch biopsies were revealed invasive adenocarcinoma of the rectum. (Figure)
The patient underwent left mastectomy with negative sentinel lymph node biopsy. At the same
session low anterior resection with total abdominal hysterectomy and bilateral salpingo-
oophorectomy were performed, as the tumor was invaded to vagina and cervix. Partial
ureterectomy and double-j catheterization was also performed, because there was an invasion to
the left ureter. Breast lesion was 1.5 cm pleomorphic variant invasive lobular carcinoma, CK7
and GCDFP 15 was positive. Lesion in the transverse colon diagnosed as low graded
adenocarcinoma as a third different cancer focus.
Conclusion:
Multiple primary tumors can include variable types and localizations of tumors. Adjuvant
treatments after breast surgery may lead to multiple primary tumors in long term follow up
despite of increased survival.
Figure. Legends detected with imaging modalities.
Biography
I was born in 1985 in Konya. I graduated from Istanbul University, Cerrahpasa Medical Faculty
(English Program). Between 2007-2009 I served on the student representative council. I began
my General Surgery residency at the same faculty in 2011. In 2014, I was elected as President of
the Turkish Surgical Society’s Resident Committee. I’m currently listed as an editor in the
journal Medicine. In addition, I’m one of the founding members of the Turkish Young Doctors’
Platform and Association and currently their vice President. My research interests are endocrine
surgery new technologies in medicine in terms of diagnostics and treatment modalities.