Li Qiu-Li, Ma Jin-An, Li Hai-Peng, Huang Ren-Bing, Hu Chun-Hong, Liu Xian-Ling, Gao Ya-Wen, Feng Gang-Hua, Wu Fang
Department of Oncology, The Second Xiangya Hospital of Central South University, Changsha, China; Depatment of Neurology, The First People's Hospital of Chenzhou, University of South China, Chenzhou, China.
Department of Oncology, The Second Xiangya Hospital of Central South University, Changsha, China.
Curr Probl Cancer. 2017 Nov-Dec;41(6):413-418. doi: 10.1016/j.currproblcancer.2017.09.002. Epub 2017 Sep 25.
Multiple primary malignant neoplasms (MPMNs) are rare malignant neoplasms that simultaneously or successively occur in the same patient as 2 or more primary malignancies. Currently, an increasing number of cases are being reported. In general, MPMNs more commonly occur as 2 solid tumors or 2 hematological malignancies. Cases of MPMN that involve a solid tumor and a hematological malignancy are rare. Here, we report a case of synchronous colorectal cancer (CRC) and multiple myeloma (MM) with chest wall involvement. After reviewing the literature, we believe that there may be a distinct syndrome involving CRC and MM. The patient in our case study suffered refractory anemia following surgery and 2 cycles of chemotherapy. Initially, the anemia was considered to be a common manifestation of CRC in this patient. Interestingly, although he received a blood transfusion, his hemoglobin levels remained low. He later developed hematuria, proteinuria, multiple osteoporosis in the costal bones, and thrombocytopenia. These new symptoms drew our attention, and we considered a diagnosis of synchronous primary CRC and MM, with the anemia as a symptom of MM. Based on the results of a bone marrow aspirate, MM was confirmed. Therefore, when CRC is associated with refractory anemia, we should not only assume that anemia is a classical symptom of CRC, a result of chronic blood loss, nutritional deficiencies, or myelosuppression due to chemotherapy, but we should also consider that it may reflect the possibility of a coexisting hematologic malignancy. As the treatment of these 2 malignancies is different, early diagnosis and treatment based on definitive diagnosis as early as possible will be beneficial to overall prognosis.
多原发性恶性肿瘤（MPMNs）是罕见的恶性肿瘤，在同一患者中同时或相继发生2种或更多原发性恶性肿瘤。目前，报告的病例数量在增加。一般来说，MPMNs更常见的表现为2种实体瘤或2种血液系统恶性肿瘤。涉及实体瘤和血液系统恶性肿瘤的MPMNs病例很少见。在此，我们报告1例伴有胸壁受累的同步性结直肠癌（CRC）和多发性骨髓瘤（MM）病例。在查阅文献后，我们认为可能存在一种涉及CRC和MM的独特综合征。我们病例研究中的患者在手术和2个周期化疗后出现难治性贫血。最初，贫血被认为是该患者CRC的常见表现。有趣的是，尽管他接受了输血，但其血红蛋白水平仍然很低。他后来出现血尿、蛋白尿、肋骨多处骨质疏松和血小板减少。这些新症状引起了我们的注意，我们考虑诊断为同步性原发性CRC和MM，贫血是MM的症状。根据骨髓穿刺结果，确诊为MM。因此，当CRC伴有难治性贫血时，我们不仅应认为贫血是CRC的典型症状，是慢性失血、营养缺乏或化疗导致骨髓抑制的结果，还应考虑它可能反映了并存血液系统恶性肿瘤的可能性。由于这2种恶性肿瘤的治疗方法不同，尽早基于明确诊断进行早期诊断和治疗将有利于总体预后。
