V Lakshmipriya, Grace Priyadarshini Sarah, Agarwal Neha, B S Padmapriya
Department of Pathology, Saveetha Medical College and Hospital, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, IND.
Cureus. 2024 Mar 20;16(3):e56607. doi: 10.7759/cureus.56607. eCollection 2024 Mar.
Multiple primary tumors are rare but their incidence is increasing nowadays with advancements in diagnostic methods and the extended survival of individuals previously treated for malignancies. However, synchronous occurrence of gastric cancer (GC) and colonic cancer (CC) is a rare entity. A 41-year-old male came with complaints of epigastric pain associated with anorexia, rapid weight loss, and occasional constipation. Contrast-enhanced computed tomography (CECT) of the abdomen and pelvis reported mucosal thickening in the antrum, likely GC with circumferential wall thickening of the transverse colon with pericolic fat stranding suggestive of CC. Upper gastrointestinal endoscopy and colonoscopy were also done and a biopsy was taken from representative sites, which confirmed malignancy. He completed three cycles of chemotherapy preoperatively and underwent subtotal gastrectomy, D2 lymphadenectomy, gastrojejunostomy, jejunojejunostomy, and transverse colectomy simultaneously. Histopathological examination confirmed moderately differentiated gastric adenocarcinoma penetrating into the subserosa and well-differentiated colonic adenocarcinoma invading the muscularis propria. Immunohistochemical analysis of mismatch repair (MMR) proteins was done to determine the association with hereditary nonpolyposis colorectal cancer syndrome (HNPCC) or Lynch syndrome. The patient underwent postoperative chemotherapy along with immunotherapy. To conclude, synchronous occurrence of primary GC and primary CC with similar MMR protein expression in immunohistochemistry is an uncommon entity.
多原发性肿瘤较为罕见，但随着诊断方法的进步以及既往接受过恶性肿瘤治疗的个体生存期延长，其发病率如今正在上升。然而，胃癌（GC）和结肠癌（CC）同时发生是一种罕见情况。一名41岁男性因上腹部疼痛伴厌食、体重快速减轻和偶尔便秘前来就诊。腹部和盆腔的增强计算机断层扫描（CECT）报告胃窦黏膜增厚，可能为胃癌，横结肠壁周向增厚伴结肠周围脂肪条索，提示结肠癌。还进行了上消化道内镜检查和结肠镜检查，并从代表性部位取了活检，证实为恶性肿瘤。他术前完成了三个周期的化疗，同时接受了胃次全切除术、D2淋巴结清扫术、胃空肠吻合术、空肠空肠吻合术和横结肠切除术。组织病理学检查证实为中分化胃腺癌侵及浆膜下层，高分化结肠腺癌侵及固有肌层。进行错配修复（MMR）蛋白的免疫组织化学分析以确定与遗传性非息肉病性结直肠癌综合征（HNPCC）或林奇综合征的关联。该患者术后接受了化疗及免疫治疗。总之，原发性胃癌和原发性结肠癌在免疫组织化学中具有相似的MMR蛋白表达同时发生是一种罕见情况。
