RESUMO
BACKGROUND Synchronous malignancies are primary cancers that are diagnosed in a single individual within a 2-month period. Synchronous malignancies are uncommon, involving only 2.4-8% of all cancer cases, with a very low number of cases of simultaneous gastric and pancreatic cancer. Although cases of synchronous malignancies do exist, synchronous pancreatic adenocarcinoma and signet ring cell (SRC) gastric adenocarcinoma have not been documented. CASE REPORT A 76-year-old woman with a previously diagnosed intraductal papillary mucinous neoplasm (IPMN) presented with left-sided abdominal pain. Initial workup, including computed tomography imaging and endoscopic ultrasound with biopsy, led to the diagnosis of pancreatic adenocarcinoma. Within 1 month of diagnosis, the patient underwent an extended Whipple procedure and was also found to have a primary SRC gastric adenocarcinoma on evaluation of the gastric tissue margins that were removed during the procedure. The patient was initiated on chemoradiation therapy with 5-fluorouracil. However, following a subsequent decline in performance status and multiple hospitalizations, she could not tolerate further cancer treatment and died soon afterwards. CONCLUSIONS Few cases of synchronous malignancies involving the stomach and pancreas have been reported. Because gastric cancer could easily be missed on screening endoscopy; physicians must have a high index of suspicion. In those patients with a prior history of cancer, biopsies should be performed to aid in early diagnosis. To our knowledge, only metachronous cases of SRC gastric and pancreatic adenocarcinoma have been documented. Therefore, this report represents the first case of synchronous SRC gastric adenocarcinoma and IPMN-associated pancreatic adenocarcinoma in the literature.
Assuntos
Adenocarcinoma Mucinoso , Adenocarcinoma , Carcinoma Ductal Pancreático , Carcinoma de Células em Anel de Sinete , Neoplasias Primárias Múltiplas , Neoplasias Intraductais Pancreáticas , Neoplasias Pancreáticas , Neoplasias Gástricas , Adenocarcinoma/diagnóstico , Adenocarcinoma Mucinoso/diagnóstico , Adenocarcinoma Mucinoso/patologia , Idoso , Carcinoma Ductal Pancreático/patologia , Carcinoma de Células em Anel de Sinete/diagnóstico , Feminino , Humanos , Neoplasias Primárias Múltiplas/patologia , Neoplasias Pancreáticas/diagnóstico , Neoplasias Pancreáticas/patologia , Neoplasias Gástricas/diagnóstico , Neoplasias PancreáticasRESUMO
There is a paucity of studies investigating the impact of chronic corticosteroid use for coexisting conditions in patients with Coronavirus Disease 2019 (COVID-19). Additionally, the information regarding the impact of chronic liver disease (CLD) on COVID-19 outcomes is evolving. Our study aims to investigate hospitalization outcomes of patients with COVID-19 on long term corticosteroids for coexisting conditions while also seeking to compare outcomes between such patients with a history of CLD to analyze the impact on mortality. We conducted a retrospective chart review across our 10-hospital network identifying patients on chronic corticosteroids (Prednisone ≥ 5 mg daily dose or equivalent dose of another steroid, for a duration of 30 days or more) who were hospitalized with COVID-19 from March 1, 2020 to June 30, 2020. Of these patients who met inclusion criteria, patients were then divided into groups based upon their history of CLD. Primary outcomes of the study looked to investigate the hospitalization outcomes of patients with a history of CLD and comorbid conditions requiring chronic corticosteroid use. Secondary outcomes sought to further investigate risk factors for mortality in our study sample. 837 charts were reviewed. 139 patients met inclusion criteria of which 34 patients had a history of CLD. Statistical analysis demonstrated no difference in length of hospital stay but increased ICU admission rate in the CLD group (41.2% vs 23.8%). No statistically significant difference was seen in between the CLD and non-CLD groups in term of complication rates and 28-day mortality. However, chronic corticosteroids patients were found to have higher rates of ICU admission and overall 28-day and ICU mortality in comparison to patients who were not on chronic corticosteroids prior to COVID-19 hospitalization. The larger contributor to COVID-19 severity was likely chronic corticosteroid use rather than CLD and thus chronic corticosteroid use should be limited throughout the COVID-19 pandemic especially in patients with additional speculated risk factors for COVID-19 such as CLD.