Concomitant adenocarcinoma and non-Hodgkin's lymphoma, both located in the intestinal tract, are unusual. Collision tumors of the colon on the other hand are extremely rare neoplasms. A case of true collision tumor of a marginal zone lymphoma and a moderately differentiated adenocarcinoma of the ascending colon (hepatic flexure) is reported. Simultaneously, a third primary is identified as follicular lymphoma involving the terminal ileum. Correlation with clinical history, radiology investigations, endoscopic findings and histological examination of the resected specimen as well as the use of ancillary techniques such as immunohistochemistry are the most useful in making the correct diagnosis of a synchronous three primaries involving the small bowel and colon. Therefore, we present these three primary synchronous neoplasms involving two different parts of the gastrointestinal tract, with two of these three primaries colliding at one organ.
Synchronous cancers are defined as malignant tumours that occur simultaneously, each of which must be distinct with no possibility of one being the metastasis of the other. A 65 year old gentleman presented to us with two month history of epigastric pain associated with anaemia, loss of appetite and weight. He has no history of malignancy in his family. Colonoscopy revealed tumours at transverse colon and caecum. Intra-operatively, tumours were sited at caecum, transverse colon and jejunum. Tumours were diagnosed as synchronous adenocarcinoma histopathologically with loss of expression of MLH1 and MSH2. From literature search, this is the first reported triple synchronous tumours of the caecum, transverse colon and jejunum. We believe that this gentleman developed triple synchronous tumour through the sporadic MSI pathway.
Inverted papilloma is a rare, benign tumour representing only 0.5 to 4 per cent of all sinonasal neoplasms; its involvement of the middle ear is extremely rare. We present a case of multicentric inverted papilloma in the sinonasal region and middle ear in a 54-year-old man. The patient later developed neck metastasis secondary to malignant transformation of the inverted papilloma in the middle ear.
Multiple dermatofibromas is a rare entity consisting of more than fifteen lesions. Multiple clustered dermatofibroma is a distinct variant of multiple dermatofibromas and is defined as a well-demarcated plaque composed of individual dermatofibromas. We report a 16-year-old boy with multiple clustered dermatofibroma in a segmental distribution, which has previously not been reported in the literature.
Papillary thyroid carcinoma (PTC) is the most common thyroid carcinoma and is derived from thyroid follicular cells. In contrast, medullary thyroid carcinoma (MTC) is rare and originates from the parafollicular C-cells. Synchronous occurrence of these two carcinomas is uncommon and occurs as either discrete lesions or as a mixed lesion. The current case report describes a 50-year-old woman with synchronous multiple discrete MTC and PTC with lymph nodes metastasis. Pathologists and treating physicians should be aware of the synchronous coexistence of these entities to avoid possible misdiagnosis.
A 43-year-old man presented with two-month history of fatigue, weakness, paleness, rectal bleeding, sweating, and weight loss of 10 kg in the past one month. A complete blood count revealed anaemia. The patient underwent a right hemicolectomy. The microscopic examination revealed an adenosquamous carcinoma associated with a mucinous adenocarcinoma in a patient with microsatellite instability due to loss of MLH1 and PMS2 expression and retention of MSH2 and MSH6 expression in both the squamous and glandular components. We also observed an atypical immunohistochemical phenotype in the adenocarcinoma component showing CK7 expression and reduced CK20 and CDX2 expression.
A rare case of choroidal malignant melanoma in a naevus of Ota is described. This is the first reported case from Asia outside the Japanese population. This case illustrates the need for close observation of all pigmented lesions of the eye.
BACKGROUND: Sebaceous nevus is a benign congenital epidermal nevus. Its association with basal cell carcinoma is well known.
METHOD: This is a case report of sebaceous carcinoma complicated by both basal cell carcinoma and squamous cell carcinoma.
RESULTS: The behavior of this tumor is very aggressive, resulting in poor prognosis.
CONCLUSIONS: All sebaceous nevi should be excised early.
Two patients, members of one family, with Peutz-Jeghers syndrome are described who underwent surgery for bowel obstruction. Both had multiple polyps in the gastrointestinal tract. Severe dysplasia and adenomatous change were present in two hamartomatous polyps adjacent to a stenosing colonic carcinoma in one patient and moderate dysplasia and adenomatous change were observed in two hamartomatous rectal polyps in his son. These changes support recent reports in the literature of progression towards neoplasia in these lesions.
The authors present an interesting case under our follow-up who has had five different forms of tumours with different pathologies throughout his lifetime. He started off with hepatoma, followed by pleomorphic sarcoma of the thigh, adenocarcinoma of the prostate, meningioma and finally schwanoma. He is still alive to this date.