Article
Complex Malignancies: A Diagnostic and Therapeutic Trilemma
A patient presented with esophageal adenocarcinoma, pulmonary small-cell carcinoma, and high-grade carcinoma, which is a rare occurrence that...
Up to 6% of patients with head and neck squamous cell carcinoma (SCC) also have synchronous second primary cancers (SPCs). However, the synchronous cancers may be missed in a usual examination that relies on CT and MRI scans.
Related: Complex Malignancies: A Diagnostic and Therapeutic Trilemma
Clinicians from Odense University Hospital in Denmark report on a patient who presented with only tongue pain as a symptom but was found to have 4 SPCs. The CT and MRI results were inconclusive due to artifacts from metal dental fillings. However, a positron emission tomography (PET)-CT scan “easily revealed” the 3 coinciding malignancies because of their increased metabolic activity, the authors say.
Their patient had 4 primary cancers: 1 SCC on the left side of the tongue, 1 in the fold between the tongue and the floor of the mouth (the 2 tumors were near each other but separate entities), a third SCC in the right aryepiglottic fold, and a grade 2 follicular lymphoma diagnosed “by coincidence” in the lymph nodes of the neck.
The 3 SCCs in the upper aerodigestive tract were in line with the concept of field cancerization, the clinicians note. Multiple adjacent but independent tumors in the mucosa may arise from exposure to carcinogens, which can induce dysplastic changes that lead to malignancy. Moreover, although synchronous cancer of the head and neck regions and follicular lymphoma are rare, one of the potential risk factors for follicular lymphoma is smoking, the authors say. Their patient had been a smoker for 56 years.
The authors recommend a “more liberal approach” to examination and a “generous use” of PET-CT for patients with malignancies of the head and neck regions, particularly in patients with obvious risk factors, such as a long history of smoking or alcohol abuse. They add that PET-CT is also a useful tool in assessing tumor dissemination and prognosis of individual carcinomas—an important benefit in planning different treatments.
Source:
Heidemann LN, Johansen J, Larsen SR, Sørensen JA. BMJ Case Rep. 2016;pii: bcr2015214047.
doi: 10.1136/bcr-2015-214047.