Hany Eskarous, MD, Ana Concha Chagime, MD, Nestor Rives Perez, MD, Kay Khine, MD; Easton Hospital, Easton, PA
Introduction: Primary esophageal cancer with synchronous primary colorectal tumors is extremely rare. Hereditary conditions such as Lynch syndrome and Peutz-Jeghers syndrome are linked to colon cancers and may increase the risk of secondary malignancies. Only a few cases of synchronous cancers of the esophagus and colon have been reported.
Methods: A 45-year-old male patient, nonsmoker, nonalcoholic, with no family history of cancer presented with fatigue, diarrhea, and fever for three days. On physical exam, he was febrile and tachycardic, mild conjunctival pallor, benign abdominal exam, and perianal tenderness. The patient had an anorectal abscess and underwent incision and drainage. His clinical status improved with fluids and antibiotics. Lab results revealed iron-deficiency anemia. Fecal occult blood was positive. Colonoscopy showed tight stricture versus circumferential mass in the distal sigmoid colon. Upper endoscopy showed a distal esophageal mass in an area of likely underlying Barrett’s esophagus. Computed tomography (CT) of the abdomen showed multifocal areas of bowel wall thickening, mesenteric adenopathy, and enhancing nodule within the splenic flexure. Pathology identified a moderately differentiated grade II esophageal adenocarcinoma and poorly differentiated ulcerated grade III recto-sigmoid adenocarcinoma with mucinous differentiation. The sample tested negative for DNA mismatch repair proteins and microsatellite instability. Immunocytochemical testing of the esophageal and rectal masses was positive for Cytokeratin 20. The esophageal tumor showed substantially more cytokeratin 7 staining than the rectal sigmoid tumor 7. PSAP and TTF-1 markers were negative. These differences favor two separate primaries. The patient responded to FOLFOX [5-FU (fluorouracil), leucovorin, and oxaliplatin] plus Bevacizumab. Discussion: Multiple primary malignant neoplasms (MPMN) defined as two or more tumors with different histologic appearances developing in different organs and giving metastases. Our patient met all the diagnostic criteria for MPMN. Patients older than 40 with iron deficiency anemia and positive FOBT should always be screened for GI malignancies. No guidelines are available for the treatment of MPMN; each patient should be considered individually, preferably by a multidisciplinary team. The type of each malignancy, the stage of the disease, and the patient’s overall health should be considered.
CT ABDOMEN AND PELVIS WITH CONTRAST showing Multifocal areas of marked small and large bowel wall thickening.
CT ABDOMEN AND PELVIS WITH CONTRAST showing A probable enhancing polyp seen in the region of the splenic flexure of the colon.
Disclosures: Hany Eskarous indicated no relevant financial relationships. Ana Concha Chagime indicated no relevant financial relationships. Nestor Rives Perez indicated no relevant financial relationships. Kay Khine indicated no relevant financial relationships.