Synchronous Hepatoblastoma and Neuroblastoma in Two Chinese Infants.

Background: Commonly, pediatric solid tumors occur independently. Only two patients with synchronous hepatoblastoma (HBL) and neuroblastoma (NBL) have been reported. Case reports: Two Chinese infants presented with abdominal mass at 10 and 8 months. Computed tomography (CT) scans in both revealed hepatic masses with additional mediastinal or adrenal masses. Pathology confirmed synchronous HBLs in the liver and NBLs in the mediastinum and adrenal. Next generation sequencing (NGS) found no remarkable germline mutations. Both patients received gross total resections with chemotherapy before or after surgery. They were followed up for 36 and 8 months, and recovered well. Conclusion: These two cases of synchronous HBL and NBL tumors lacked significant genetic alterations.

A Novel Prognostic Score Based on Multiple Quantitative Parameters of Chest CT for Patients with Synchronous Multiple Primary Lung Cancer: Is Solid Component Size a Better Prognostic Indicator?

BACKGROUND: There is no simple and definitive way to predict the prognosis of synchronous multiple primary lung cancer (SMPLC). In this study, we developed a clinical prognostic score for predicting the survival of patients with SMPLC. PATIENTS AND METHODS: This study included 206 patients with SMPLC between 2011 and 2020 at three hospitals. Kaplan-Meier analysis was used to determine the optimal cutoff values for the quantitative chest computed tomography (CT) parameters. Multivariable Cox proportional hazards regression was carried out to identify independent prognostic factors for predicting overall survival (OS) and disease-free survival (DFS). The time-dependent receiver operating characteristic curve was analyzed to evaluate the prognostic performance. RESULTS: A CT-based prognostic score (CTPS) comprising six chest CT parameters was developed. Compared with T stage, CTPS had a higher prediction accuracy for OS and DFS. All C-indices of the model reached a satisfactory level in both the development and validation cohorts. Significant differences in the OS and DFS curves were observed when the patients were stratified into different risk groups. The high-risk group (CTPS of 5-6) had poorer survival than the low-risk group (CTPS of 0-4). CONCLUSIONS: The developed CTPS and the corresponding risk stratification system are valid for predicting the survival of patients with SMPLC.

Association of the Extent of Resection with Survival in Multiple Primary Lung Cancer: A Systematic Review.

BACKGROUND: The incidence of synchronous multiple primary lung cancer (SMPLC) has progressively increased, due to recent advances in imaging. To date, no guidelines defining recommendations for patients' selection and no standard treatment of cases with SMPLC have been defined.The primary aim of this systematic review was to assess survival among patients treated with lobectomy or sublobar resection MPLC. METHODS: Comprehensive literature search of Medline, the Cochrane Library, reference lists, and ongoing studies was performed according to a prospectively registered design (PROSPERO: CRD42019115487). All studies published between 1998 and December 2020 that examined treatments with lobectomy compared to sublobar resection were included. Two double-blind investigators independently selected articles.Primary outcomes were to assess the 5-year overall survival (OS) rate among patients treated with lobectomy or sublobar resection and the impact of lymph node status on 5-year OS and 5-year disease-free survival in patients with MPLC. RESULTS: The search yielded 424 articles; 4 observational studies met the inclusion criteria and collectively evaluated 298 patients with a mean age ranging from 61.5 to 67 years. A total of 112 patients were treated for bilateral synchronous tumors and 186 patients for unilateral multiple synchronous tumors. All included studies showed that the type of resection, lobectomy or limited resection, had no significant impact on survival. CONCLUSION: Limited resection is a valuable treatment option for MPLC. However, the clinical level of evidence of the studies found is low and randomized studies are needed to clarify the extent of resection in MPLC.

[18F]FDG-PET/CT improves the detection of synchronous malignancies at primary staging of oral squamous cell carcinoma - A retrospective study.

The purpose of this study was to show the non-inferiority of [18F]FDG-PET/CT compared with panendoscopy with regards to secondary malignancies of the UADT, and to evaluate the diagnostic performance of PET/CT for detecting synchronous malignancies. Patients with newly diagnosed OSCC and both panendoscopy and [18F]FDG-PET/CT at primary staging were enrolled in this retrospective study. The accuracy in detecting synchronous malignancies was assessed for both modalities, and their diagnostic measures for the detection of malignancies within the UADT were compared. Histopathological analysis and clinical follow-up served as reference standards. In total, 182 patients were enrolled in this study. Eighteen patients (9.9%) had in total 22 synchronous malignancies, of which eight were located within the UADT. [18F]FDG-PET/CT detected all malignancies within the whole body (sensitivity: 100%) and yielded false-positive results in four cases (specificity: 97.6%). Sensitivity ([18F]FDG-PET/CT: 100% vs panendoscopy: 87.5%), specificity (99.4% vs 100%), negative predictive value (100% vs 99.4%), and positive predictive value (88.9% vs 100%) for detecting secondary UADT malignancies did not differ between modalities (all p = 0.32). Within the limitations of the study it seems that [18F]FDG-PET/CT detects synchronous malignancies of the UADT with an accuracy comparable to panendoscopy, and enables highly sensitive whole-body tumor screening in patients with newly diagnosed OSCC. This could be a relevant factor for therapeutic decision making in clinical routine.

Synchronous bilateral multifocal basal cell adenomas of the parotid gland-a case report.

BACKGROUND: Bilateral parotid gland tumors account for up to 3% of cases. In this group, the vast majority are Warthin's tumors. However, bilateral presentations of other parotid gland tumor entities is also possible, an example of which is a basal cell adenoma (BCA). Bilateral BCA is extremely rare, which could cause misdiagnosing it as a Warthin tumor. CASE PRESENTATION: The current study reports the unique case of a 48-year-old woman who presented with a 6-month history of slowly growing masses located bilaterally in the parotid region, surgically treated with 5-year follow-up (no recurrence, normal facial nerve function). Magnetic resonance imaging (MRI) revealed three lesions: two in the superficial and deep lobes of the right parotid gland, and one in the superficial lobe of the left parotid gland. A total parotidectomy with facial nerve preservation was performed on the right side, and superficial parotidectomy on the left side 6 months later. Histopathological examination confirmed that all three tumors were BCAs. Molecular analysis didn't show any strong, potential of unknown clinical significance in the studied sample. CONCLUSIONS: Multifocal bilateral lesions of the parotid gland are usually Warthin tumors. Detailed preoperative diagnostics including MRI and histopathological examination is essential to avoid misdiagnosing BCA and Warthin tumors. To our best knowledge, no case of synchronous bilateral multifocal basal cell adenomas of the parotid gland has been reported in English literature so far.

Multiple synchronous bilateral neoplasms of the parotid glands.

Abstract: In this paper we report the rare case of a patient who came to our attention with three synchronous Warthin tumours affecting both the right and left parotid glands. The patient was a 68-year-old female, heavy smoker, with a seven-year history of painless growing nodules in both pre-auricular areas. Left-sided subtotal parotidectomy and contralateral superficial parotidectomy were performed at two differ-ent surgical times. Multiple, simultaneous and bilateral Warthin tumours represent a rare pathological entity of the salivary glands. Careful preoperative examination and radiological evaluation of the salivary glands are critical for the early diagnosis of bilateral synchronous tumours.

Impact of FDG PET/CT on detection of synchronous and metachronous malignancies and clinical management in patients with multiple primary cancers.

Multiple primary cancers are usually defined as primary malignant tumors of different histological origins in one person. Recently, there has been an increase in the number of patients diagnosed with multiple primary cancers. The study aims to evaluate the role of PET/CT in detecting second primary and subsequent tumors as well as to demonstrate the influence on the treatment management in patients with histologically proven synchronous or metachronous tumors. Fifty patients with clinically proven at least one malignancy have been evaluated and followed up for a year. Another inclusion criterion was a biopsy-proven additional primary synchronous (within 2-6 months after the first one) or metachronous (more than 6 months after the diagnosis of the first one) malignant tumor in a different organ. All patients were scanned on GE Discovery PET/CT 16 slices scanner from the top of the head to mid-thigh. The study was performed one hour after injection, using the weight-adjusted activity, hydration of patients with diuretic stimulation, and oral/i.v. contrast intake. Thirty out of 50 patients were females. The youngest patient was 25 years old, while the highest age was 84 years. Ten of the patients had third primary tumors and one patient had four different malignancies. Metachronous tumors were 2.4-fold higher than synchronous ones. The minimum time to detect a second tumor was 1 month, while the maximum was 15 years. As second malignancies we detected fourteen gastrointestinal cancers (28%), ten urogenital ones (20%), ten pulmonary tumors (20%), five breast cancers (10%), four lymphoma patients (8%), four head and neck squamous cell carcinomas (8%), two NET (4%), and one sarcoma (2%). As a result of the 18F-FDG PET/CT scan, the therapy plans of all 50 patients required modification at the minimum for the second tumor. 64% of the patients had multimodality therapy for their first cancer, which suggests that this approach could play an important role in the development of MPM. 81% of the additional malignancies in the female group, detected by PET/CT were in stages I or II, which provides a higher probability of cure. On the other hand, we detected advanced stage second primary disease in 70% of the patients in the male group. PET/CT can identify a significant number of additional primary neoplasms in patients with known primary cancer, acquiring combined metabolic and morphologic information, as well as its whole-body protocol. Integrated PET/CT can significantly modify the assessment of the tumor's dissemination and often change patient management substantially. Subsequent primary lesions identified after PET/CT scan are mainly in the early stage and thus have an excellent likelihood of being cured if treated promptly and aggressively.

Radiological classification, gene-mutation status, and surgical prognosis of synchronous multiple primary lung cancer.

OBJECTIVE: To investigate the radiological classification, gene-mutation status, and surgical prognosis of synchronous multiple primary lung cancer (sMPLC). METHODS: From January 2013 to October 2019, 192 consecutive patients with sMPLC were investigated. The clinical, CT, molecular, and pathological features of all patients were analyzed. Furthermore, the prognosis of 89 patients who only underwent surgical resection was evaluated. RESULTS: Among 192 patients, all lesions pathologically confirmed or highly suspected as tumors based on radiological findings were retrospectively analyzed, and the CT findings of sMPLC were classified into three types: (I) all lesions manifested as solid nodules/masses (14.06%, 27/192), (II) all lesions manifested as subsolid nodules/masses (43.23%, 83/192), and (III) tumor lesions manifested as a combination of ≥ 2 of the following patterns: solid nodules/masses, subsolid nodules/masses, cystic airspace, and focal consolidation (42.71%, 82/192). For 252 tumors undergoing epidermal growth factor receptor (EGFR)-mutation testing, the EGFR-mutation rate was higher in subsolid tumors than that in solid tumors (p < 0.05). Among 19 patients with all tumors undergoing surgery and driver-gene testing, genetic heterogeneity was prevalent among the multiple tumors (63.16%,12/19). The highest clinical stage of non-I, ipsilateral distribution of tumors, and CT classification of I indicated a poor prognosis for patients with sMPLC (all p < 0.05). CONCLUSION: Subsolid lesions are the most common presentation of sMPLC. Genetic heterogeneity in driver mutations among sMPLC may be present. Prognosis in patients with sMPLC is determined by the highest clinical TNM stage, distribution, and radiological classification among the multiple tumors. KEY POINTS: • Synchronous multiple primary lung cancer (sMPLC) has three types of CT findings. • Genetic heterogeneity may be prevalent among the multiple tumors. • Prognosis in patients with sMPLC is associated with the highest clinical TNM stage, distribution, and radiological classification among the multiple tumors.

Coincidental or Causal? Concurrence of Colorectal Carcinoma with Primary Breast Cancer.

Multiple primary malignant neoplasms (MPMN) represent the occurrence of a second malignancy in the same patient within 6 months after the detection of first primary (synchronous) tumor, or > 6 months after primary detection (metachronous). We present a case of a patient treated for carcinoma of the breast who developed a metachronous primary malignancy in the colorectal tract. These tumors were histologically different with distinct immune-histochemical parameters. The association between breast and colon cancer is well documented in the literature with several studies reporting the coexistence of common extrinsic and genetic predisposing factors. Although rare, MPMN are becoming more common due to the increased number of elderly cancer survivors, improved diagnosis and enhanced awareness. The association between colorectal and breast cancer should not be dismissed merely as metastasis since there is good precedent for the co-occurrence of these primary tumors.

Contiguous Meningioma and B-Cell Lymphoma: A Scoping Review and Case Illustration.

BACKGROUND: The diagnosis of a contiguous, synchronous meningioma and central nervous system B-cell lymphoma is rare and associated with paradoxical treatment paradigms. We performed a scoping review of contiguous meningioma and B-cell lymphoma and included an additional illustrative case. METHODS: The OVID Medline and PubMed databases were systematically searched using the Preferred Reporting Items of Systematic Reviews and Meta-Analysis guidelines. Only human clinical reports of contiguous, synchronous meningioma and B-cell lymphoma were included. We concurrently detailed a representative case from our institution. RESULTS: Nine case reports met our criteria, including the present case. The average age at diagnosis was 67.4 years. Patients showed a female-to-male predominance of 7:2. The diagnosis of synchronous intracranial tumors was not suspected or discovered until after surgical resection in 100% of cases. All meningiomas were grade I on histopathologic diagnosis, while lymphomas were distributed between diffuse large B-cell lymphoma (56%), metastatic lymphoma (22%), Burkitt lymphoma (11%), and follicular lymphoma (11%). All patients underwent surgical resection. Patients (n = 5) treated with adjuvant chemotherapy had evidence of longer progression-free survival (median 12 months; range, 3-18 months) than patients without adjuvant chemotherapy (n = 2; median 2 months; range, 1-3 months). CONCLUSIONS: Contiguous, synchronous meningioma/B-cell lymphoma is a rare diagnosis that may appear as an inconspicuous solitary intracranial neoplasm on imaging. Based on the limited cases and current treatment of lymphoma, progression-free survival may be contingent on the prompt initiation of chemotherapy targeting the lymphoma rather than surgical resection of the meningeal mass. Providers should prioritize prompt medical management.

Synchronous mucosal and intraosseous oral cavity carcinomas: a case of rare occult second primary malignancy.

Secondary primary malignancies within the head and neck region are well documented. Within this group, synchronous tumours with an index oral cancer are usually found in the oropharyngeal or laryngeal sites. We present a rare case of an index squamous cell carcinoma in the tongue with a synchronous primary intraosseous squamous cell carcinoma. We discuss the challenges associated with investigation, diagnosis and subsequent management. Treatment aims remain the same; namely, eradicating the disease using surgery, radiotherapy, chemotherapy or a combination of these modalities. It is important to acknowledge the unpredictable pattern of tumour presentation and the need to maintain a high index of suspicion.

The Utility of Gastrointestinal Endoscopic Examination Versus Positron Emission Tomography-Computed Tomography in the Detection of Second Primary Lesions in Korean Patients With Head and Neck Cancer.

OBJECTIVE: Head and neck cancer often accompany a synchronous secondary primary lesion in the digestive tract. The aim of this study was to compare detection rates between positron emission tomography-computed tomography (PET-CT) and esophagogastroduodenoscopy (G-fiber) or colonoscopy (C-fiber) in the initial staging and to analyze risk factors for premalignant, malignant, and total synchronous secondary primary lesions. METHODS: A total of 739 patients with head and neck cancer who underwent PET-CT, G-fiber, or C-fiber were analyzed retrospectively. RESULTS: Positron emission tomography-CT did not definitely detect any premalignant synchronous secondary primary lesions (0 [0%] of 739) but definitely detected 10 malignant synchronous secondary primary lesions (10 [1.35%] of 739). Esophagogastroduodenoscopy or C-fiber detected all 20 premalignant synchronous secondary primary lesions (20 [2.71%] of 739) and all 37 malignant synchronous secondary primary lesions (37 [5.00%] of 739). The patients with nasopharynx cancer tended to have premalignant synchronous secondary primary lesions (odds ratio [OR]: 3.793; 95% CI: 1.414-10.171; P = .008). Those with distant metastasis tended to have premalignant (OR: 4.743; 95% CI: 1.508-14.916; P = .009), malignant (OR: 3.803; 95% CI: 1.486-9.731; P = .005), and total synchronous secondary primary lesions (OR: 2.753; 95% CI: 1.159-6.538; P = .022). CONCLUSIONS: Premalignant or malignant synchronous secondary primary lesions that were not definitely detected by PET-CT could be found in the endoscopic examination.

A Rare Case of Primary Neuroendocrine Carcinomas in the Ear and Throat and Review of Literatures.

The neuroendocrine carcinomas (NECs) of the head and neck are rare. The purpose of this article is to explore the diagnosis and treatment of NECs in the ear and larynx. We report a case of a patient with NECs found in the ear and throat simultaneously, and the relevant literatures are reviewed. It is difficult to identify which is the original site. There is no specific clinical manifestation of NECs in the ear and throat, and carcinoid syndrome is a rare situation. Surgery is still the preferred treatment for this disease. For patients with metastasis, radiotherapy and/or chemotherapy are required.

Impact of pre-operative breast magnetic resonance imaging on contralateral synchronous and metachronous breast cancer detection-A case control comparison study with 1468 primary operable breast cancer patients with mean follow-up of 102 months.

BACKGROUND: Women with unilateral breast cancer are at an increased risk for the development of contralateral breast cancers. We hypothesis that combined breast MRI would detect more contralateral synchronous breast cancer than conventional imaging alone, and resulted in less contralateral metachronous breast cancer during follow-up. METHODS: We retrospectively collected two groups of breast cancer patients diagnosed from 2009 to 2013 for evaluating the effectiveness and value of adding pre-operative breast MRI to conventional breast images (mammography and sonography) for detection of contralateral synchronous breast cancer. The new metachronous contralateral breast cancer diagnosed during follow-up was prospectively evaluated and compared. RESULTS: Group A (n = 733) comprised patients who underwent conventional preoperative imaging and group B (n = 735) combined with MRI were enrolled and compared. Seventy (9.5%) of the group B patients were found to have contralateral lesions detected by breast MRI, and 65.7% of these lesions only visible with MRI. The positive predictive value of breast MRI detected contralateral lesions was 48.8%. With the addition of breast MRI to conventional imaging studies, more surgical excisions were performed in contralateral breasts (6% (44/735) versus 1.4% (10/733), P< 0.01), more synchronous contralateral breast cancer detected (2.9% (21/735) versus 1.1% (8/733), P = 0.02), and resulted in numerical less (2.2% (16/714) versus 3% (22/725), p = 0.3) metachronous contralateral breast cancer during a mean follow-up of 102 months. CONCLUSIONS: Our study provides useful estimates of the pre-operative breast MRI for the increased detection of contralateral synchronous breast cancer and less subsequent contralateral metachronous breast cancer.

Evaluation of lung tumor motion in a large sample: Target-related and clinical factors influencing tumor motion based on four-dimensional CT.

BACKGROUND AND PURPOSE: We aimed to analyze the influence of target-related and clinical factors on lung tumor motion based on four-dimensional CT (4DCT), and clarify the motion based on subgroups in lung stereotactic body radiation therapy. MATERIALS AND METHODS: 4DCT image data of 267 tumors from 246 patients were analyzed. The coordinates in the left-right (LR), anterior-posterior (AP), and cranial-caudal (CC) directions of the center of mass (COM) of the gross tumor volumes in 10 phases of 4DCT were measured. The peak-to-peak COM displacement in the LR, AP, CC, and 3D directions was calculated. The influence of target-related and clinical factors on tumor motion was evaluated using multivariate analysis. RESULTS: The tumor segment location correlated with the tumor motion in each direction. Tumor size was predictive of tumor motion in the 3D (p = 0.023) and AP directions (p = 0.049). The tumor motion for metastatic tumors was smaller than that for primary tumors in the LR (p = 0.019) and AP directions (p = 0.008). The CC motion for pulmonary surgery recipients (3.8 ± 4.5 mm) was less than that for patients who had not undergone surgery (5.6 ± 5.4 mm), and no significant clinical factor was observed. BSA and BMI were positively correlated with the motion in the CC (p = 0.02) and LR directions (p = 0.002). CONCLUSION: The tumor segment location was a good predictor of tumor motion. A larger tumor tends to have a smaller motion. Patients with metastatic tumors or those who have undergone pulmonary surgery exhibited smaller and more unpredictable tumor motions, which required individual assessments. Thus, clinical factors can potentially predict tumor motion.

Synchronous bilateral breast cancer treated with a 3-week hypofractionated radiotherapy schedule: clinical and dosimetric outcomes

Background and purpose Synchronous bilateral breast cancer (SBBC) accounts for 1–3.5% of breast cancer patients. The aim of this study was to evaluate dosimetric issues, clinical outcomes, and acute toxicities for SBBC patients receiving synchronous bilateral hypofractionated radiotherapy (SBHRT) and to compare them with patients treated with synchronous bilateral normofractionated RT schedule (SBNRT). Materials and methods From April 2016 to March 2020, 39 SBBC patients were referred to our institution. Patients were divided according to their prescription dose: Group A: 50 Gy/25fx (fractions), B: 60–64 Gy/25fx, C: 40.05 Gy/15fx; D: 48 Gy/15fx. Toxicity was evaluated using Common Terminology Criteria for Adverse Events (CTCAE)v.5.0. Results 34 patients were finally evaluated. Median follow-up was 24 months for NF schedule and 9 months for HF schedule. In the HF schedule, no acute side-effects > G2 were observed and no dermatitis was reported in 6th month´s assessments. 95% of patients have no evidence of disease and only 1 patient presented local relapse in the first mammography after RT. No distant failures or deaths were observed. Regarding dosimetric issues, the inter-patient average Dmean for the heart was: Group A: 5.0 Gy (4.6–5.5), Group B: 4.4 Gy (4.1–5.4), Group C: 4.8 Gy (4.5–5.1) and Group D: 5.3 Gy (4.4–5.6). For the lungs, the inter-patient average Dmean was: Group A: 10.8 Gy (9.8–12.2), Group B: 11.5 Gy (11.3–12), Group C: 9.8 Gy (9.3–10.5) and Group D: 10.5 Gy (10–11.3). Conclusions This is the first study reporting the safety, feasibility, and tolerability of 40.05 Gy/15fx over 3 weeks for the treatment of SBBC patients. Further study with larger accrual is mandatory (AU)