Multiple Primary Malignancies With Hypercalcemia Presentation: A Case Report

Abstract

Multiple primary malignancies (MPMs) are defined as having more than one primary malignancy and when each tumor is histologically distinct and unrelated to the others. Multiple risk factors have been found to be associated with MPMs. These include familial syndromes, sequela from treatments of previous malignancies, and environmental factors such as smoking, alcohol consumption, obesity, and male sex. Hypercalcemia has a well-known association with malignancy and is often the first abnormality that leads to further testing. Lung cancer followed by colorectal cancer has the highest mortality of all cancers in the USA, with adenocarcinoma being the most prevalent histological subtype. Further, estimates show that those with one malignancy have a 1.29 times higher risk of developing another malignancy. Hereby, we present a case of a patient with squamous cell carcinoma of the lung who presented with hypercalcemia and incidentally was found to have another primary adenocarcinoma of the colon.

Keywords: colorectal cancer; lung squamous cell carcinoma; multiple primary cancers; paraneoplastic hypercalcemia; rectal adenocarcinoma.

Figure 1. CXR showing left chest wall mass (arrow), with erosions of the third and fourth ribs. The mass measures at least 7 × 8.5 cm in size as it projects into the left lung. The right lung remains clear. The cardiac and mediastinal contours appear normal.

Figure 2. Chest CT showing a large lobulated mass (arrow) with partially spiculated margins medially, estimated at 8.4 × 9.5 × 9.7 cm in its greatest dimension. It demonstrates heterogeneous enhancement with peripheral neovascularization. It has invaded through the upper left chest wall with destruction of the left second to fourth ribs. It is abutting the superior aspect of the fifth rib.

Figure 3. Circumferential wall enhancement of the mid-rectal segment, suspicious for an “apple core” neoplastic process (arrow). The inferior aspect is located at approximately 6.5 cm from the anal verge. This disease segment measures 7.2 cm in length. Neovascularization is noted.

Figure 4. Rectal mass biopsy showing superficial mucosal tissue lined by highly atypical dysplastic/neoplastic glandular epithelial cells with nuclear pleomorphism, prominent nucleoli, and frequent mitotic figures. This is consistent with at least intramucosal adenocarcinoma. Invasive growth cannot be excluded.