Synchronous Invasive Breast Carcinoma, Endometrial Cancer and Small Lymphocytic Lymphoma in a 49 Year-old Female Libyan Patient: Case Report and Literature Review

Although breast cancer and endometrial cancer are two frequent female cancers, finding synchronous primary cancers in the same patient is a comparatively uncommon occurrence. We present the case of a Libyan woman who developed synchronous breast cancer, endometrial cancer, and small lymphocytic lymphoma. For the previous six months, a 49-year-old female patient had a right breast mass. An ultrasound scan revealed an uneven doubtful growth in the right breast as well as swollen of the axillary lymph nodes. After a wide local excision, histopathology revealed that the patient had invasive ductal carcinoma of the breast with a positive resection margin, and he was admitted to the Surgery Department. No distal metastasis was seen on a computed tomography (CT) scan of the chest, abdomen, or pelvis, so the patient had a right mastectomy and axillary clearance. Residual invasive ductal carcinoma was found on histopathology and immunohistochemistry with positivity for the estrogen receptor and the progesterone receptor. Small lymphocytic lymphoma (SLL) affected the axillary lymph nodes, affirmed by immunohistochemical staining positive for CD20, CD5, CD23 and BCL-2 while negative for CD3 and Cyclin D1. Resection margins were free. Second cancers are characterized by being linked to SCL, and some researchers have described that the risk of second cancers is elevated in SCL patients. We represent a combined case of synchronous primary SCL with breast cancer and endometrial cancer in a woman which is a rare occurrence.

Thymic Carcinomas and Second Malignancies: A Single-Center Review

Thymic carcinomas account for less than 0.01% of new cancer diagnoses annually and are more aggressive than thymomas. Autoimmune disorders have been associated with thymomas and only recently with thymic carcinomas. Second malignancies are well described after thymomas. The aim of this study was to analyze the incidence of second malignancies in patients with thymic carcinomas. All cases of thymic carcinomas were identified from the pathology archives of Indiana University. Histological materials were reviewed and further correlated with clinical data to identify incidence of second cancers in patients with thymic carcinomas. Histological material was available for review in 92 cases of thymic carcinoma. Clinical data were available for 85 patients. Fourteen of these (16.5%) patients had a second malignancy; these included small cell lung carcinoma, “testicular cancer”, embryonal carcinoma, seminoma, breast carcinoma (two cases), prostatic adenocarcinoma, Hodgkin’s lymphoma, thyroid carcinoma, bladder carcinoma (two cases), renal cell carcinoma, and melanoma. The latter could precede, be concurrent with, or follow the diagnosis thymic carcinoma. The incidence of second cancers in patients with thymic carcinomas is similar to that reported for thymomas. Abnormalities in immunological surveillance may be responsible for this high incidence of second malignancies in thymic tumors.

Factors Modifying Outcome After MIBG Therapy in Children With Neuroblastoma—A National Retrospective Study

BackgroundNeuroblastoma is the most common pediatric extracranial tumor with varied prognoses, but the survival of treated refractory or relapsing patients remains poor.ObjectiveThis analysis presents the outcomes of children with neuroblastoma undergoing MIBG therapy in Poland in 2006-2019.Study DesignA retrospective cohort of 55 patients with refractory or relapsed neuroblastoma treated with I-131 MIBG in Poland in 2006-2019 was analyzed. The endpoints were overall survival (OS), event-free survival (EFS), cumulative incidence (CI) of second cancers and CI of hypothyroidism. Survival curves were estimated using the Kaplan-Meier method and compared between the cohorts by the log-rank test. Cox modeling was adopted to estimate hazard ratios for OS and EFS, considering factors with P < 0.2.ResultsFifty-five patients with a median age of 78.4 months (range 18-193) with neuroblastoma underwent one or more (4 patients) courses of MIBG I-131 therapy. Fifteen patients were not administered chemotherapy, 3 children received standard-dose chemotherapy, and 37 patients were administered high-dose chemotherapy (HDCT) (busulfan-melphalan in 24 and treosulfan-based in 12 patients). Forty-six patients underwent stem cell transplantation, with autologous (35 patients), haploidentical (6), allogeneic (4), and syngeneic grafts (1). The median time from first MIBG therapy to SCT was 22 days. Children with relapsing tumors had inferior OS compared to those with primary resistant disease (21.2% vs 58.7%, p=0.0045). Survival was better in patients without MYCN gene amplification. MIBG therapy was never curative, except in patients further treated with HDCT with stem cell rescue irrespective of the donor type. 31 patients were referred for immune therapy after MIBG therapy, and the 5-year OS in this group was superior to the untreated children (55.2% vs 32.7%, p=0.003), but the difference in the 5-year EFS was not significant (25.6% vs 32.9%, p=ns). In 3 patients, a second malignancy was diagnosed. In 19.6% of treated children, hypothyroidism was diagnosed within 5 years after MIBG therapy.ConclusionMIBG therapy can be incorporated into the therapeutic strategy of relapsed or resistant neuroblastoma patients as preconditioning with HDCT rather than stand-alone therapy. Follow-up is required due to the incidence of thyroid failure and risk of second cancers.

Second Cancers in a Patient with Gastric MALT Lymphoma

Mucosa-associated lymphoid tissue (MALT) lymphoma is an extranodal low-grade B-cell lymphoma, which is thought to arise from a background of chronic immune stimulation, bacterial, viral, or autoimmune stimuli. Treatment advances have increased the number of MALT lymphoma survivors, but there is still debate as to whether these patients are at a higher risk of developing second cancers. This is a case of a long-surviving (>20 years) patient with multiple diagnosed malignancies following MALT lymphoma. We describe how modern oncological treatment plans can provide patients with prolonged survival and increased quality of life despite increasing age and multiple malignancies.