Quadruple primary urogenital cancers - A case report

Abstract

Introduction: Urogenital cancers are not an uncommon occurrence in daily practice. Prostate cancer is the second most frequent cancer in men, kidney cancer accounts for 2.4% of all cancers and bladder cancers represent 3.1% of cancers in both men and women [1]. However, the cases of a simultaneous development of all three cancers, including one with a neuroendocrine component, are very few and far between.

Presentation of case: Our case report involves a case of a patient with prostate adenocarcinoma, clear-cell renal carcinoma, papillary renal carcinoma and small-cell bladder cancer. The patient was treated as if he had separate pathologies by a multidisciplinary team: surgical and oncological, performing radical cystoprostatectomy with left perifascial nephroureterectomy, right ureterostomy and adjuvant chemotherapy, with excellent outcome even four years after the initial diagnosis.

Discussion: The distinct features of this case are the occurence of four different malignancies of the urogenital system, the family history of colon cancer, the development of small-cell carcinoma of the bladder, which is extremely rare and the good outcome, despite the quadruple malignancies and the aggresivity of the small-cell carcinoma.

Conclusion: Mutiple primary malignancies are a relatively rare pathology, but should be considered as a possibility in patients who already had a second malignancy. Cases of patients with MPMs should be supervised by a multidisciplinary team and should be followed closely.

Keywords: Cancers; Case report; MPMs; Multiple primary; PCDH17; PMs; TCF21; Urogenital; multiple primary malignancies; primary malignancies; protocadherin involved in cell adhesion functions; transcription factor involved in tissue differentiation.

Fig. 1

Ultrasonography and elastography captures of the bladder and prostate cancers.

Fig 2

Ultrasonography captures of renal cancer and simple renal cyst.

Fig. 3

Intravenous urography.

Fig 4

Computed-tomography of the abdomen and pelvis showing unenhanced and enhanced characteristics of the renal and bladder tumor, as well as the simple cyst.

Fig. 5

Surgical specimen.

Fig 6

Surgical specimen with the corresponding histopathological slides.

Fig. 7

Immunohistochemical staining.