Triple primary cancer of the head and neck, skin and prostate: A case report and literature review

Abstract

Second primary cancer (SPC) is an important prognostic factor for patients with head and neck cancer (HNC); therefore, the association between the prognosis and development of SPC has been well-reported. The use of 2-[¹⁸F]-fluoro-2-deoxy-D-glucose-positron emission tomography (FDG-PET) is valuable to examine cancer stage, evaluate treatment responses and investigate suspected relapses or metastases. In the present study, the case of a male patient who was diagnosed with three primary cancer types, including well to moderately differentiated squamous cell carcinoma (SCC) of the mandible, axillary cutaneous poorly differentiated SCC and prostate adenocarcinoma, was described. Among these, mandible cancer was the first diagnosed when the patient was 70 years of age. Synchronous skin and prostate cancer (PRC) types then developed 3 years later. To the best of our knowledge, this is the first report of the aforementioned combination of cancer types. Postoperative FDG-PET was not performed as no lesions of recurrence or metastases of mandible cancer were found. Three years later, the PRC was asymptomatic and was incidentally detected by FDG-PET performed for a preoperative evaluation of skin cancer. It was indicated that FDG-PET could be utilized in patients with HNC due to there being no accurate FDG-PET protocol to detect SPC over a long-term follow-up.

Keywords: 2-[18F]-fluoro-2-deoxy-D-glucose-positron emission tomography; head and neck cancer; multiple primary neoplasms; prostate cancer; second primary; skin cancer.

Figure 1.

Histological examination of the mandible tissue by hematoxylin and eosin staining. Atypical squamous cells and cancer pearls are observed in the alveolar bone of the mandible, with intercellular bridges (arrow), which are characteristics of well-differentiated squamous cell carcinoma. Magnification, ×200; scale bar, 100 µm.

Figure 2.

Contrast-enhanced computed tomography results indicating resorption in the right mandible and suspected tumor invasion (arrow) (axial section).

Figure 3.

Preoperative use of 2-[18F]-fluoro-2-deoxy-D-glucose-positron emission tomography/computed tomography (axial section). Metabolic activity was detected in the prostate (maximum standardized uptake value, 4.61) (arrow).

Figure 4.

Histological examination of the skin tissue by hematoxylin and eosin staining. Irregular nests and cords composed of atypical squamous cell without keratinization infiltrate the dermis and subcutaneous tissue, and spindle-shaped cells are observed (arrow), which are characteristics of poorly differentiated squamous cell carcinoma. Magnification, ×100; scale bar, 100 µm.

Figure 5.

Histological examination of the prostate tissue by hematoxylin and eosin staining. Solid strands without glandular lumina invade the stroma (arrow). Magnification, ×200; scale bar, 100 µm.