An unusual occurrence of multiple primary malignant neoplasms: a case report and narrative review

Abstract

Introduction: Multiple primary malignant neoplasms (MPMNs) are cancers presenting distinct pathological types that originate from different tissues or organs. They are categorized as either synchronous or metachronous. Nowadays, the incidence of MPMN is increasing.

Patients and methods: We present a case of a 71-year-old male patient with a medical history of hepatitis B and a family history of breast and endometrial cancers. The patient reported a nasal tip skin lesion with recurrent bleeding, and the history disclosed lower urinary tract symptoms. Further investigations revealed the coexistence of four primary cancers: basosquamous carcinoma of the nasal lesion, prostatic adenocarcinoma, hepatocellular carcinoma, and clear cell renal cell carcinoma.

Results: A multidisciplinary team cooperated to decide the proper diagnostic and therapeutic modules.

Conclusion: To the best of our knowledge, the synchronization of these four primary cancers has never been reported in the literature. Even so, multiple primary malignant neoplasms, in general, are no longer a rare entity and need proper explanations, a precise representation of definition and incidence, further work-up approaches, and treatment guidelines as well.

Keywords: basosquamous carcinoma; clear renal cell carcinoma; hepatocellular carcinoma; multidisciplinary team; multiple primary malignant neoplasms; prostatic adenocarcinoma.

Figure 1

Histopathologic features of the patient’s nasal tip skin lesion punch biopsy. H&E (×10): the tumor is composed of a nest of basaloid cells with peripheral palisading (red shadow) and features of BCC admixed with areas of squamoid cells (blue shadow).

Figure 2

Abdomen and pelvis axial CT scan. (A, B) Hepatic isodense round lesions in the right lobe: a 5-cm lesion in segment four (A) and a 3.5-cm lesion in the dome of the liver (B), with heterogeneous enhancement in the portal phase. In addition to two smaller enhanced lesions in segment eight (B), the liver was normal in size and shape. (C, D) Right renal heterogeneously enhanced 4-cm lesion, arising from the right renal cortex, distorting adjacent mid-calyx and renal pelvis; (C) with and (D) without contrast. (E) An enlarged prostate of 6.3 cm projected to the base of the urinary bladder. All intended lesions are marked with arrows.

Figure 3

Needle biopsy of the prostate gland. H&E (×10): adenocarcinoma with cribriform pattern. (A) The right side of the gland with a Gleason score of 6 (3 + 3), grade group 1; (B) the left side of the gland with a Gleason score of 7 (4 + 3), grade group 3.

Figure 4

Biopsy of the right kidney tumor. H&E (×10): clear cell renal cell carcinoma, with WHO/ISUP histologic grade 3, and tumor pathologic stage of PT1b Nx Mx.

Figure 5

Core biopsy of the hepatic mass. H&E (×10): well-differentiated hepatocellular carcinoma.