Mathew Reshmi, Churchill Gregory, Cheema Bakht, Desai Ketav, Alkhasawneh Ahmad, Liu Shiguang, Siddiqi Anwer
Internal Medicine, University of Florida College of Medicine - Jacksonville, Jacksonville, USA.
Gastroenterology, University of Florida College of Medicine - Jacksonville, Jacksonville, USA.
Cureus. 2022 Jun 2;14(6):e25607. doi: 10.7759/cureus.25607. eCollection 2022 Jun.
Multiple primary malignant tumors (MPMTs) are two or more separate malignancies found at different sites concurrently. Prior studies have shown that the most common tumor associations in MPMTs are typically between two tumors in the digestive system. We present a case of a male patient in his 60s who initially presented with melena and was found to have a clean-based gastric ulcer on initial endoscopic evaluation. Repeat endoscopy on later admission revealed persistent ulceration. Biopsy showed Epstein-Barr virus (EBV) positive lymphoepithelioma-like gastric carcinoma (LELGC), a rare gastric malignancy. The patient underwent endoscopic ultrasound (EUS) for assessment of tumor depth and involvement of perigastric lymph nodes, but was incidentally found to have a liver lesion. Biopsy of the liver lesion was positive for hepatocellular carcinoma (HCC) with no morphologic similarity to the gastric malignancy. This case highlights a rare finding of MPMTs. In addition to the diagnosis of a rare gastric malignancy, the patient developed a well-known but uncommon phenomenon of non-cirrhotic HCC associated with hepatitis C virus (HCV). Due to an increasing number of advances in cancer therapy that are leading to increased survival times, clinicians can expect for a patient to develop MPMTs in their lifetime. A high index of suspicion must exist for the possibility of MPMTs because treatment options and outcomes can be vastly affected by their findings.
多原发性恶性肿瘤（MPMTs）是指在不同部位同时发现的两个或更多独立的恶性肿瘤。先前的研究表明，MPMTs中最常见的肿瘤关联通常发生在消化系统的两种肿瘤之间。我们报告一例60多岁男性患者，最初表现为黑便，初次内镜检查发现为基底干净的胃溃疡。后来再次入院时重复内镜检查显示溃疡持续存在。活检显示为 Epstein-Barr 病毒（EBV）阳性的淋巴上皮瘤样胃癌（LELGC），这是一种罕见的胃恶性肿瘤。患者接受了内镜超声（EUS）检查以评估肿瘤深度和胃周淋巴结受累情况，但偶然发现有肝脏病变。肝脏病变活检显示为肝细胞癌（HCC），与胃恶性肿瘤无形态学相似性。该病例突出了MPMTs的罕见发现。除了诊断出一种罕见的胃恶性肿瘤外，患者还出现了与丙型肝炎病毒（HCV）相关的非肝硬化性HCC这种常见但不常见的现象。由于癌症治疗的进展越来越多，导致患者存活时间延长，临床医生可以预期患者在其一生中会发生MPMTs。对于MPMTs的可能性必须保持高度怀疑，因为其检查结果会极大地影响治疗选择和预后。
