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Case Reports
. 2024 Mar 4;86(4):2348-2351.
doi: 10.1097/MS9.0000000000001881. eCollection 2024 Apr.

Secondary neoplasm to non-hodgkin lymphoma treatment manifesting as a cancer of unknown primary: the first case in literature

George Bashour  1   2 , Nina Kheyrbek  1   2 , Ali Dway  1   3 , Elias Salloum  1   2 , Michael Georgeos  1   4 , Zuheir Alshehabi  1   5
Affiliations
Case Reports

Secondary neoplasm to non-hodgkin lymphoma treatment manifesting as a cancer of unknown primary: the first case in literature

George Bashour et al. Ann Med Surg (Lond). .

Abstract

Introduction: Cancer of unknown primary (CUP) is a tumour metastasis with no detectable primary origin. A secondary neoplasm (SN) is defined as a tumour secondary to a prior tumour treatment and has no histological relation to that primary tumour.

Case presentation: The authors report a case of a 72-year-old female patient who presented with back pain and had a history of non-Hodgkin lymphoma (NHL) treated with RCHOP 12 years ago. MRI showed a compression fracture in T5 and T7 vertebrae, while the PET/computed tomography (CT) only showed hypermetabolic lytic bone lesions in these vertebrae. Pathological examination of a biopsy of these lesions suggested metastatic breast cancer, but the mammography was normal. The above clinical description indicates that our case is a SN to RCHOP treatment manifested as a cancer of unknown origin.

Discussion: CUP is diagnosed when all screening procedures fail to find the original tumour. On the other hand, the literature showed that RCHOP treatment of non-Hodgkin lymphoma has a 0.68% chance of causing a SN. After an extensive literature search, we found that our case, which has the combination of both CUP and SN, is the first documented case.

Conclusion: This case suggests that cancer patients who received chemical or radiological treatment should be screened more carefully on the long term as it is possible to developed secondary neoplasms without a primary tumour in areas difficult to diagnose with traditional screening tools.

Keywords: cancer of unknown primary; immunohistochemistry; secondary neoplasm.

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Conflict of interest statement

The authors declare no conflict of interest.Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article.

Figures

Figure 1
Figure 1
Magnetic resonance imaging shows: T1, compression fracture in T5 and T7 with backward displacement of the vertebral body in (A). T2, compression of the thoracic spinal cord (B). T1, no changes or injury in the lumbar area (C).
Figure 2
Figure 2
Histopathology of the tumour: Low power view shows infiltration of bone tissue by atypical neoplastic epithelial cells, occurring in cords, glandular/ductal, and isolated forms [hematoxylin and eosin (H&E), 100×] (A), The neoplastic cells dissecting between necrotic tissue, showing hyperchromatic nuclei, scanty basophilic cytoplasm, and occasional mitotic figures (H&E, 200×) (B).
Figure 3
Figure 3
Immunohistochemistry of the tumour biopsy: CK-positive (A), CK7-positive (B), ER-positive (C), PR-negative (D), GATA-3-positive (E), P-53-negative (F), TTF-1-negative (I), WT-1-negative (G), PAX-8-negative (H).
Figure 4
Figure 4
Mammography of both left (A) and right (B), breasts show no pathological changes BI-RADS stage: 2/6.
See this image and copyright information in PMC

References

    1. Rassy E, Assi T, Pavlidis N. Exploring the biological hallmarks of cancer of unknown primary: where do we stand today? Br J Cancer 2020;122:1124–1132. - PMC - PubMed
    1. Lee MS, Sanoff HK. Cancer of unknown primary. BMJ 2020;371:m4050. - PubMed
    1. André M, Mounier N, Leleu X, et al. . Second cancers and late toxicities after treatment of aggressive non-Hodgkin lymphoma with the ACVBP regimen: a GELA cohort study on 2837 patients. Blood 2004,103:1222–1228. - PubMed
    1. Friedberg JW. Secondary malignancies after therapy of indolent non-Hodgkin’s lymphoma. Haematologica 2008;93:336–338. - PubMed
    1. Morton LM, Onel K, Curtis RE, et al. . The rising incidence of second cancers: patterns of occurrence and identification of risk factors for children and adults. Am Soc Clin Oncol Educ Book 2014;34:e57–e67. - PubMed

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