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A4146 - Pulmonary Metastasis in a Patient with Multiple Primary Adenocarcinomas: A Case Report
Author Block: L. Fernandez1, C. A. Calderon2, L. F. Sua Villegas3, C. S. Leib4, Biomedical Research Group in Thorax; 1Interventional Pulmonology, Fundacion Valle del Lili, Universidad Icesi, Cali, Colombia, 2Internal Medicine Resident, Fundacion Valle del Lili, Universidad CES, Cali, Colombia, 3Departament of Pathology and Laboratory Medicine, Fundacion Valle del Lili, Universidad Icesi, Calli, Colombia, 4Medical Research, Fundacion Valle del Lili, Universidad Icesi, Cali, Colombia.
INTRODUCTION Cancer diagnosis increases with age, which is also a risk factor for the development of multiple malignant neoplasms. Patients with a primary tumor are at an 8,5% risk of developing secondary tumors. The incidence of primary neoplasms varies between 2,4% and 8%; 26% of the secondary presentations are synchronous and 74% are metachronous. We describe the case of a patient with multiple primary adenocarcinomas who develops pulmonary nodules, requiring further evaluation. CASE REPORT A 76 year old female with previous history of diabetes mellitus II and hypothyroidism presents with multiple primary adenocarcinomas including a well-differentiated ductal adenocarcinoma of the head of the pancreas with extensive vascular and perineural compromise, stage T2N0M0, managed with a distal pancreaticoduodenectomy, splenectomy and radical lymphadenectomy; an apocrine ductal carcinoma in situ of the breast, stage T3N0M0 with negative hormone receptors, managed with a mastectomy and neoadjuvant chemotherapy; a multifocal papillary thyroid carcinoma, stage T1AN0M0, compromising the left vocal cord, managed with total thyroidectomy, radioactive iodine therapy and lymphadenectomy; and a gastrointestinal stromal spindle cell lesion, without necrosis but positive CD117, CD34, actin and desmin. A multi-gene panel test is performed for hereditary cancer syndromes (MyRISK) with complete sequencing and MLPA for BRCA1, BRCA2 with a negative result; and later MLPA and sequencing for APC, ATM, BARD1, BMPR1A, BRIP1, BRIP1, CDH1, CDK4, CDKN2A, CHECK2, EPCAM, MLH1, MSH2, MSH6, MUTYH, NBN, PALB2, PMS2, PATEN, RAD51C, RAD51D, SMAD4, STK11 and TP53 showing variants of uncertain significance and MLH1 polymorphism. Due to the positivity of serum cancer antigen 19-9, a PET-CT scan is performed identifying hypermetabolic nodules in the lingula and the left lower lobe. The patient is taken to lobectomy and wedge resection; pathology report is notable for a metastatic adenocarcinoma originated in the pancreas. NAB-Paclitaxel is initiated with complete remission. DISCUSION In this case the patient had breast, pancreatic, thyroid and gastrointestinal adenocarcinomas, with metastatic lesions in the lung of pancreatic origin. In the literature similar reports have not been described; however hormone associated carcinomas such as simultaneous ovarian, breast, uterine and thyroid malignancies have been reported before. Cases of primary lung adenocarcinoma associated with colorectal (22%), breast (18,4%), and gastric (14,4%) neoplasms have also been illustrated. Hereditary cancer syndromes such as Lynch syndrome, Von Hippel-Lindau syndrome, Li-Fraumeni syndrome and multiple endocrine neoplasia must be studied in this patient. Here, the available genetic tests were inconclusive and the case requires further evaluation.