TRIPLE SYNCHRONOUS PRIMARY LUNG AND ESOPHAGEAL TUMORS IN AN ADULT: A RARE AND NOVEL OCCURRENCE

Abstract

SESSION TITLE: Medical Student/Resident Lung Cancer Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: October 18-21, 2020 INTRODUCTION: Synchronous multiple primary tumors (MPTs) are uncommon, with only a few cases published in the literature. We present a 60-year-old man diagnosed with three primary cancers, including pulmonary mucinous adenocarcinoma, schwannoma, and metastatic esophageal adenocarcinoma. This report highlights the diagnostic enigma and the importance of watching for a subsequent primary tumor in patients receiving their initial cancer diagnosis. CASE PRESENTATION: A 60-year-old smoking Hispanic man presented to the ED for a few weeks of dysphagia and weight loss. His father had liver cancer. Clinically, he was malnourished, and laboratory workup was unremarkable. A chest X-ray showed a 3.7 cm left pleural mass and a 2.5 cm right hemithorax nodule. Chest CT confirmed prior findings and showed mid-esophageal thickening for which, an EGD with biopsy reported moderately differentiated esophageal adenocarcinoma. Biopsy of the right lung nodule revealed well-differentiated mucinous adenocarcinoma, and left lung mass showed a spindle cell lesion consistent with schwannoma. A subsequent PET scan showed metastatic mediastinal lymph nodes and a right femoral neck focus; biopsy proved metastatic adenocarcinoma, consistent with an esophageal primary. Therefore, the patient was diagnosed with three primary cancers. The management decision was prioritized based on the most life-threatening tumor, which, in this case, was the metastatic esophageal cancer. Therefore, he was started on palliative chemotherapy with XELOX (capecitabine plus oxaliplatin) and Xgeva (denosumab) for bone metastases. After eight months of follow-up, the patient is still alive. DISCUSSION(S): MPTs are becoming more prevalent with advancing age and improved therapeutic modalities, bearing more diagnostic conundrums and treatment hurdles. MPTs are named synchronous or metachronous, based on whether less than or more than six months period between the first and subsequent tumor diagnosis. The synchronous group has a poorer prognosis and could further be subclassified into simultaneous or sequential groups based on 60 days mark towards the timing of subsequent tumor diagnosis with a statistically significant decline in survival identified in the sequential group. Because of the perplexity of its management and outcomes, a multidisciplinary team discussion involving the patient and family during the decision-making process is crucial to reach a consensus regarding the management plan. CONCLUSION(S): To the best of our knowledge, this is the first reported case of synchronous unrelated coinciding triple primary tumors, including pulmonary mucinous adenocarcinoma, esophageal adenocarcinoma, and pulmonary schwannoma in a single patient. Further research is needed to define the true extent of this ailment in order to learn more about the clinical characteristics and patient-specific risk factors, which will ultimately enhance early detection and prognosis. Reference #1: Skelton WP 4th, Ali A, Skelton MN, et al. Analysis of Overall Survival in Patients With Multiple Primary Malignancies: A Single-center Experience. Cureus. 2019;11(4):e4552. Published 2019 Apr 27. doi:10.7759/cureus.4552 Reference #2: Vogt A, Schmid S, Heinimann K, et al. Multiple primary tumours: challenges and approaches, a review. ESMO Open. 2017;2(2):e000172. Published 2017 May 2. doi:10.1136/esmoopen-2017-000172 Reference #3: Li F, Zhong WZ, Niu FY, et al. Multiple primary malignancies involving lung cancer. BMC Cancer. 2015;15:696. Published 2015 Oct 14. doi:10.1186/s12885-015-1733-8 DISCLOSURES: No relevant relationships by Surabhi Amar, source=Web Response No relevant relationships by Dawood Findakly, source=Web ResponseCopyright © 2020 American College of Chest Physicians