Clinical analysis of multiple primary gastrointestinal malignant tumors:A 10-year case review of a single-center

BACKGROUND Multiple primary malignant tumors(MPMTs)was first described by Billroth as early as 1889,with the first report published by Warren and Gates in 1932.Since then,numerous cases have been reported.A literature review of 1104269 patients with cancer revealed that the incidence of MPMTs ranged from 0.73 to 11.7%.In recent years,however,there has been a significant upward trend in the incidence of this phenomenon,which may be associated with many different factors,including the advancement of modern diagnostic procedures facilitating the examination and diagnosis of more MPMTs,increased exposure to chemotherapy and radiotherapy that exacerbate the risk of new malignant tumors in patients with cancer,and prolonged survival of patients with cancer allowing sufficient time for the development of new primary cancers.AIM To analyze the incidence,clinical features,treatment factors,prevalence,and prognosis of patients with MPMTs in the gastrointestinal tract treated in a single center.Additionally,we analyzed the different tumor combinations,time interval between the occurrence of tumors,and staging.METHODS This retrospective cohort study analyzed 8059 patients with pathologically confirmed gastrointestinal malignant tumors treated at the Gansu Province Hospital in Lanzhou,Gansu,China between June 2011 and June 2020.Of these,85 patients had MPMTs.The clinical features,treatment factors,prevalence,and prognosis of this latter cohort were analyzed.RESULTS The incidence of MPMTs in patients with gastrointestinal malignant tumors was 1.05%(85/8059),including 83 double primary malignant tumors and two triple primary malignant tumors of which 57(67.06%)were synchronous MPMTs(SMPMTs)and 28(32.94%)were metachronous MPMTs(MMPMTs).The most frequent associations were found between the rectum colon cancers within the SMPMT category and the gastric-colon cancers within the MMPMT category.For the MMPMTs,the median interval was 53 months.The overall 1-,3-and 5-year survival rates from diagnosis of the first primary cancer were 91.36%,65.41%,and 45.97%,respectively;those from diagnosis of the second primary cancer were 67.90%,29.90%,and 17.37%,respectively.CONCLUSION MPMTs in the gastrointestinal tract have a high incidence and poor prognosis.Thus,it is necessary to perform both gastroscopy and colonoscopy in patients with gastrointestinal tumors.Multidisciplinary comprehensive diagnosis and treatment may improve the diagnosis rate and treatment efficiency of MPMTs.

X-ray diagnosis of synchronous multiple primary carcinoma in the upper gastrointestinal tract

AIM:To analyze the radiological features of multiple primary carcinoma (MPC) in the upper gastrointestinal (GI) tract,study its biological characteristics and evaluate X-ray examination in its diagnosis. METHODS:Hypotonic double-contrast GI radiography was performed in 59 multiple primary carcinoma cases,pathologically proved by surgery or endoscopy biopsy. Radiological findings were analyzed. RESULTS:Of the 59 cases,esophageal MPC (EMPC) was seen in 24,esophageal and gastric MPC (EGMPC) in 27 and gastric MPC (GMPC) in 8. Of the 49 lesions found in 24 EMPC,hyperplastic type was seen in 23,medullary type in 9. The lesions were located at the upper (n = 17),middle (n = 19) or lower (n = 13) segment of the esophagus. In 27 EGMPC,the esophageal lesions were located at the middle (n = 16) or lower (n = 11) segment of the esophagus,while the gastric le-sions were located at the gastric cardia (n = 16),fundus (n = 1),body (n = 3) and antrum (n = 7). The esophageal lesions were mainly of the hyperplastic type (n = 12) or medullary type (n = 7),while the gastric lesions were mainly of the hyperplastic type (n = 18). A total of 119 lesions in the 59 patients with synchronous multiple carcinoma were proved by surgery or endoscopy biopsy,and preoperative upper radiographic examination detected 100 of them (84.03% sensitivity). Eighteen (52.94%) of the T1 lesions were found during preoperative diagnosis by radiographic examination. Moreover,only 3 (3.53%) of the T2-4 lesions were misdiagnosed. CONCLUSION:Hypotonic double-contrast upper gastrointestinal examination,providing accurate information about lesion morphology,location and size,can serve as a sensitive technique for the preoperative diagnosis of MPC.

Synchronous multiple primary malignancies of the esophagus, stomach, and jejunum: A case report

BACKGROUND Treatment of synchronous multiple primary malignancies is quite often very challenging.Herein,we report on a rare case of synchronous multiple primary malignancies in the esophagus,stomach,and jejunum.CASE SUMMARY A 50-year-old man who was a heavy drinker and smoker with a poor diet,and had a family history of cancer sought treatment due to dysphagia lasting for 4 mo.He was finally diagnosed with lower esophageal squamous cell carcinoma(pT3N2M0,G2,stage IIIB),gastric angular adenocarcinoma(pT3N2M0,G2-G3,stage IIIA)with greater omental lymph node metastasis,and jejunal stromal tumor(high risk).The high-risk jejunal stromal tumor was found during surgery.In spite of radical resection and adjuvant chemotherapy,lymph node metastasis occurred 21 mo later.The patient responded poorly to additional chemotherapy and refused further examination and therapy.He died of widespread metastases 33 mo after surgery.CONCLUSION This case indicates a poor prognosis of synchronous multiple advanced primary malignancies and the importance of comprehensive assessment in the population at high risk for cancer.

Genetic characteristics of a patient with multiple primary cancers:A case report

BACKGROUND Two or multiple primary malignant neoplasms(MPMNs)rarely occur in the same patient.It has been reported that MPMNs are easily misdiagnosed as the recurrence or metastasis of malignancies in clinical practice,affecting the choice of treatment for the patients,thereby resulting in the delay of optimal diagnosis.Next generation sequencing(NGS)can be used to distinguish between multiple primary lung cancers and intrapulmonary metastasis,and may distinguish the origin of tumours in different sites of the body.CASE SUMMARY We report the case of 66-year-old woman who suffered from different malignant neoplasms in the rectum and esophageal and gastrointestinal tract.The first neoplasm rectal adenocarcinoma was diagnosed and removed in 2016.The second and third lesions were diagnosed with esophageal squamous-cell carcinoma(ESCC)and gastrointestinal stromal tumour(GIST),respectively,in 2019.Nextgeneration whole exome sequencing was performed on the tissue specimens of rectal carcinoma,esophageal cancer,GIST,and white blood cells to investigate the relationship between malignancies at different timeframe and determine whether the ESCC and GIST evolved from the rectal adenocarcinoma.Mutations including v-Ki-ras2-Kirsten rat sarcoma viral oncogene homolog,adenomatosis polyposis coli,and mothers against decapentaplegic homolog 4 were detected in rectal adenocarcinoma sample,mast/stem cell growth factor receptor was detected in GIST tissue,and lysine methyltransferase 2D was detected in ESCC specimen.Overall,ESCC and GIST were not genetically evolved from rectal adenocarcinoma,and this patient did not have a trunk driven clone.CONCLUSION NGS is an effective tool to study clonal evolution of tumours and distinguish between MPMNs and intrapulmonary metastasis.

A case of simultaneous triple primary gastrointestinal tumor

Multiple primary carcinoma which is the same organ of the same patient or multiple organs, tissues has occurred two or more than two kinds of the primary malignant tumor. All cancer at the same time or 6 months from diagnosis is called simultaneous multiple primary carcinoma. In this case the patient suffering from cancer including rectal cancer, colon cancer and appendix gastrointestinal stromal tumor(GIST) three primary carcinoma, is simultaneous multiple primary carcinoma and it's extremely rare on the clinical cases. This report address that the incidence of the patient with operation and pathological diagnosis.

多原发恶性肿瘤114例的临床病理特征分析

目的分析多原发恶性肿瘤(MPMT)患者的临床病理特征。方法回顾性收集2021年1月至2023年7月于空军军医大学西京医院诊断为MPMT患者的临床病理资料。结果共纳入114例MPMT患者,同时性MPMT患者42例(36.8%),异时性MPMT患者72例(63.2%);男性58例(50.9%),女性56例(49.1%);双原发恶性肿瘤101例(88.6%),三原发恶性肿瘤10例(8.8%),四原发恶性肿瘤3例(2.6%)。第一原发恶性肿瘤诊断中位年龄54(10,78)岁。第一原发恶性肿瘤中分布占前三位的是消化道[39.5%(45/114)]、头颈部[15.8%(18/114)]和女性生殖系统[14.9%(17/114)]恶性肿瘤。第二原发恶性肿瘤中分布占前三位的是消化道[36.0%(41/114)]、呼吸系统[22.8%(26/114)]和肝胆胰[17.5%(20/114)]恶性肿瘤。第一原发恶性肿瘤接受手术、化疗、放疗分别有88例(77.2%)、44例(38.6%)、18例(15.8%)。结论通过临床病理特征分析,提高对MPMT的了解,本文中消化道恶性肿瘤发病率高,临床应注意鉴别。

消化道不同部位印戒细胞癌中的SATB2、CDX2表达水平及临床意义

目的探讨核基质结合蛋白2(SATB2)、尾型同源异型框转录因子-2(CDX2)在消化道不同部位印戒细胞癌(SRCC)中的表达水平及临床意义。方法收集2008年3月1日至2019年1月31日漯河市中心医院收治的265例消化道手术切除SRCC标本,其中上消化道SRCC患者178例,下消化道SRCC患者87例。比较消化道不同部位SRCC组织中SATB2、CDX2阳性率及不同病理学参数的SRCC组织中SATB2、CDX2阳性率。结果SATB2、CDX2在食管(28.57%、28.57%)、胃(27.71%、40.96%)SRCC组织中的阳性率明显低于十二指肠(80.00%、60.00%)、空回肠(50.00%、50.00%)、阑尾(88.89%、66.67%)、结肠(89.47%、70.18%)、直肠(89.47%、68.42%)SRCC组织中的阳性率,差异均有统计学意义(P<0.05);SATB2、CDX2在上消化道SRCC组织中的阳性率分别为29.21%、41.01%,明显低于下消化道SRCC组织中的88.51%、68.97%,差异均有统计学意义(P<0.05);上消化道、下消化道SRCC组织中Ⅲ+Ⅳ期SATB2阳性率分别为43.75%、95.87%,明显高于Ⅰ+Ⅱ期的12.20%、77.50%,CDX2阳性率分别为57.29%、85.11%,明显高于Ⅰ+Ⅱ期的21.95%、50.00%,差异均有统计学意义(P<0.05);上消化道、下消化道SRCC组织中T_(3)+T_(4)期SATB2阳性率分别为44.55%、10.00%,明显高于T_(1)+T_(2)期的9.09%、79.59%,CDX2阳性率分别为57.43%、84.21%,明显高于T_(1)+T_(2)期的19.48%、84.21%,差异均有统计学意义(P<0.05)。结论SATB2、CDX2在不同部位的SRCC组织中表达水平不同,尤其在下消化道SRCC中SATB2、CDX2阳性表达率更高,可用于早期诊断消化道SRCC,且对评估SRCC严重程度有一定价值。

上尿路尿路上皮癌术后膀胱复发的研究进展

尿路上皮癌(UC)是泌尿男性生殖系肿瘤中排名第2位的恶性肿瘤,其中上尿路尿路上皮癌(UTUC)约占5%~10%。有22%~47%的患者在根治术后出现膀胱内肿瘤复发(IVR)。本文就UTUC行根治术后IVR的机制、特征、相关危险因素、术后定期膀胱监测、诊断治疗方案以及预防措施等作一综述,以期助益于临床工作。

上消化道多原发癌X线诊断(附44例报告)

目的 分析上消化道多原发癌的X线表现 ,探讨其生物学特征及X线诊断价值。资料与方法 44例上消化道多原发癌 ,均行上消化道低张气钡双对比造影 ,所有病例均经内镜或术后病理证实。结果 44例中 ,食管多原发癌 2 2例 ,占 5 0 %;食管 胃多原发癌 19例 ,占 43.2 %;胃多原发癌 3例 ,占 6 .8%。除 1例食管发现 3处癌灶外 ,其余皆为双灶。 2 2例食管多原发癌共发现 45个癌灶 ,其中增生型病变 2 0个 ,髓质型 9个 ,溃疡型和浸润型各 7个 ,混合型 2个。病变位于食管上段者 15个 ,中段者 17个 ,下段者 13个。 19例食管 胃多原发癌中 ,食管癌灶皆位于中下段 ,其中中段 11个 ,下段 8个 ;胃部病变贲门占 13个 ,胃底和胃体各 1个 ,胃窦 4个。食管病变以增生型和髓质型居多 ,分别为 7和 5个 ;胃部病变以增生型最多 ,有 14个。结论 上消化道多原发癌以食管多源和食管 胃多源多见。食管癌灶以增生型为多 ,其次为髓质型。病变部位以中下段较多见。胃部病变多发生于贲门 ,增生型最多见。X线气钡双对比造影是诊断上消化道多原发癌的重要手段。

窄带成像技术在诊断上消化道多原发癌中的应用价值

目的探讨窄带成像技术在诊断上消化道多原发癌中的应用价值。方法 2010年6月—2011年6月,接受胃镜检查患者2 452例。对检查中发现的可疑病灶分别使用普通白光内镜和窄带成像内镜观察病灶的形态、范围,同时应用放大内镜手动变焦观察黏膜表面腺管开口及微血管形态。对活检病理确诊的癌灶采用超声内镜、腹部CT或手术标本病理进行T分期。结果 2 452例患者中检出多原发癌13例,均为同时双原发癌,检出率为0.53%。13例患者中合并早期癌的比例为30.8%(4/13),包括食管原位癌2例,胃黏膜内癌2例。结论早期癌在上消化道多原发癌中并不少见,但病灶隐匿,普通白光内镜检查容易漏诊,NBI可以提高其检出率。

高频超声内镜鉴别上消化道黏膜内癌及黏膜下癌

目的探讨高频超声内镜鉴别上消化道黏膜内癌及黏膜下癌的价值。方法129例上消化道早期癌患者术前行高频超声内镜检查,分析上皮内癌、黏膜肌层癌、黏膜下癌的超声影像学特征。34例行内镜下黏膜切除术,5例行内镜下黏膜下剥离术,90例行外科手术。术后标本行病理学检查确定其浸润深度。结果高频超声内镜显示上皮内癌30例,黏膜上皮层增厚,黏膜肌层形态规则;黏膜肌层癌42例,36例黏膜层及黏膜肌层增厚,两层界限不清楚,黏膜下层形态规则,6例黏膜层及黏膜肌层增厚,黏膜下层部分稍增厚,形态规则;黏膜下癌57例,黏膜下层形态改变,变细8例,增粗6例,扭曲5例,不规则10例,部分中断12例,与黏膜肌层分界不清楚16例,固有肌层形态规则。术后病理:黏膜内癌78例,黏膜下癌51例。高频超声内镜判断黏膜内癌特异性为92.2%(47/51),敏感性为87.2%(68/78),黏膜下癌特异性为87.2%(68/78),敏感性为92.2%(47/51),其鉴别黏膜内癌及黏膜下癌准确性为89.1%(115/129)。结论高频超声内镜能较准确鉴别上消化道黏膜内癌及黏膜下癌。

上消化道同时性多原发癌28例胃镜检查和临床特征分析

背景:上消化道同时性多原发癌(SC)的发病率正逐渐上升,目前缺乏对其内镜特点和临床特征的认识,极易漏诊,延误治疗。目的:分析上消化道SC的胃镜和临床特点,提高早期诊断率。方法:对内镜下可疑病灶采用染色、放大观察,多点取材病理检查,对管腔狭窄者应用超细胃镜检查,并回顾性分析患者的相关临床特征。结果:3183例上消化道恶性肿瘤共中检出上消化道SC28例,占0.9%。其中年龄>40岁且有腹痛、饱胀、烧心、吞咽不畅等非特异性症状者19例(67.9%);有食欲减退、体质量减轻、贫血等报警症状者3例(10.7%);有上消化道肿瘤高危因素者5例(17.9%)。结论:可疑人群的色素放大内镜、超细胃镜检查对上消化道SC的早期诊断有重要意义。

原发性肝癌介入治疗后并发急性上消化道出血的原因及处理

目的探讨原发性肝癌介入治疗后并发急性上消化道大出血的原因及其处理方法。方法原发性肝癌258例经股动脉插管至肝固有动脉,注入化疗药及碘油(10～30mL)混悬剂。结果27例介入治疗后出现上消化道出血,经降低门静脉压等治疗,19例出血停止,8例死亡。结论碘油逆流入门静脉引起门静脉压升高和加重原有门静脉高压是出血的主要原因,降低门静脉压是治疗该症的有效方法。

上消化道同时性多原发癌临床X线分析(附24例报告)

目的:分析上消化道同时性多原发癌的X线表现,探讨其X线诊断价值及漏诊误诊原因。方法:对经病理证实的同时性上消化道多原发癌的X线资料进行回顾性分析。结果:24例上消化道多原发癌中,食管-食管型10例,食管-胃型9例,胃-胃型5例,除2例食管为3处癌灶外,其余均为双癌灶。食管共发现31个癌灶,上段6个,中段13个,中下段4个,下段8个,中、下段合计25个,占80.6%。胃部病变中贲门6个,胃底2个,胃体3个,胃窦7个。24例中漏诊、误诊8例。结论:X线检查诊断上消化道多原发癌具有重要价值,但应警惕上消化道多原发癌易于漏诊、误诊。

同时性上消化道多原发癌20例

目的 :探讨同时性上消化道多原发癌的诊断及外科治疗。方法 :对 1 990年至 2 0 0 3年间2 0例上消化道多原发癌的临床资料结合文献进行分析。结果 :食管病变以中下段多见 ,胃部病变多见于贲门 ,上消化道钡餐造影检查确诊 4例 (2 5 % ) ,胃镜检查确诊 1 2例 (70 .6 % ) ,8例患者术前漏诊。结论 :对食管贲门癌病人 ,应常规进行上消化道钡餐造影检查及胃镜检查 ,对早期病变行胃镜下碘染色检查 ,同时术中进行仔细的手术探查 ,可提高上消化道多原发癌的诊断率 。

多原发性胃肠道恶性肿瘤的临床诊治

目的探讨多原发性胃肠道恶性肿瘤的诊断和治疗。方法回顾分析8例患者的临床资料。结果同时癌1例，异时癌7例，癌灶位于胃、十二指肠和大肠。术前正确诊断5例，误诊3例。根治性切除6例，姑息性切除和改道手术各1例。随访1～18年，健在的5例，未见再次异时癌发生。结论通过对多原发性胃肠道恶性肿瘤临床病理特征的认识，有助于提高多原发性胃肠道恶性肿瘤的诊治水平。

奥曲肽治疗原发性肝癌并发上消化道出血止血疗效观察

目的:观察奥曲肽治疗原发性肝癌并发上消化道出血的疗效。方法:47例原发性肝癌并发上消化道出血随机分为两组,治疗组25例用奥曲肽治疗,对照组22例用垂体后叶素治疗,观察并比较两组的疗效、止血时间、输血量。结果:治疗组总有效率为84％,对照组总有效率为45.4％,两组比较有显著差异(x^2=7.74,P<0.01)。治疗组的止血时间(36±14)h显著少于对照组(96±18)h,P<0.01)。治疗组的平均输血量明显少于对照组(431±56)ml对(782±8)ml,P<0.01)。结论:奥曲肽止血作用迅速、可靠,为治疗肝癌并发上消化道出血的首选药物。

上消化道多原发癌特征及诊治新进展

我国多原发癌中消化道多原发癌所占比例最大，相对于单发病灶，多原发癌一旦漏诊或误诊，将直接影响患者手术术式、治疗方法的选择及预后情况。近年来随着影像学检查技术的发展以及对该病认识的提高，相关研究逐渐增多，相较于日本等地，我国报道的上消化道多原发癌检出率差异较大。本文总结近期国内外相关文献，对其诊断、临床特点、治疗、预后及发病机制等方面的研究情况进行综述，以提高临床医生对上消化道多原发癌的认识。

上消化道多原发癌的X线表现及漏、误诊原因分析

目的 探讨上消化道多原发癌的X线表现及漏、误诊原因。方法 分析12例上消化道多原发癌的X线表现。结果 所有癌瘤均位于食管中段至胃小弯间,12例中术前X线明确诊断1例(83％),11例(91.7％)术前X线漏、误诊。结论 上消化道多 原发癌X线检查易发生漏、误诊,提高对本病的认识有助于正确的诊断。

微泵注射生长抑素在原发性肝癌并上消化道出血病人治疗中的观察及护理

报告56例原发性肝癌并上消化道出血行微泵注射生长抑素治疗的观察及护理特点。强调严格控制药物的浓度、注射速度及操作规范,严密观察病情变化,是保证成功抢救病人和更好地进行后续治疗及防止并发症发生的关键。