Triple synchronous primary malignancies of the colon, endometrium and kidney (Lynch syndrome/MSH6)... Ovarian Cancer and Us OVARIAN CANCER and US Ovarian Cancer and Us

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Thursday, June 23, 2016

Triple synchronous primary malignancies of the colon, endometrium and kidney (Lynch syndrome/MSH6)...



open access:
Triple synchronous primary malignancies of the colon, endometrium and kidney in a patient with Lynch syndrome treated via minimally invasive techniques

Gynecol Oncol Rep. 2016 Aug; 17: 29–32.
Published online 2016 May 25

1. Introduction

Synchronous primary tumors of the female reproductive tract are not rare conditions. Double primary malignancies have been extensively studied, with the most frequent synchronous neoplasms being endometrial and ovarian cancers. Triple primary malignancies, on the other hand, are very rare and it is necessary to distinguish the malignancies as primary versus metastases. To our knowledge, there have been few studies in the literature that demonstrate the existence of triple simultaneous neoplasms (Isin Dogan Ekici et al., 2006, Hale et al., 2011, Takatori et al., 2014, Phupong et al., 2007, Ozan et al., 2008, Capilna et al., 2014).

In this report, we identify and present the findings from a patient with synchronous endometrial carcinoma, renal cell carcinoma and mucinous adenocarcinoma with signet ring cell features of the colon. We believe this to be the first report of this histological combination of malignancies. Genetic testing of the patient was positive for a deleterious mutation in MSH6, suggestive of Lynch syndrome. A multidisciplinary surgical approach helped our patient have combined procedures done via minimally invasive approaches at one sitting with excellent surgical outcomes.

2. Case

A 60-year-old, Hispanic female gravida 3 para 3 postmenopausal female presented with symptoms of abdominal pain, bloating, flatulence, diarrhea and urinary frequency and postmenopausal bleeding. She was referred by her gynecologist after endometrial biopsy showed moderately differentiated endometrial adenocarcinoma. On preoperative PET imaging (Fig. 1) she also had a 6 cm right upper pole renal mass that was suggestive of renal cell carcinoma and a lesion in the transverse colon seen at the time of colonoscopy consistent with either a primary malignancy or metastatic disease. The patient had no significant medical or gynecologic history and a BMI of 26.3. Her family history was significant for an uncle with colon cancer (age 60), a sister with ovarian cancer (age 45), her mother had breast (age 33) and uterine cancer (age 60) and a grandmother with uterine cancer (age 50). Until now, no other family member had been tested for any hereditary cancer mutations.

Preoperative PET/CT scan showing the renal lesion.
After careful review of her history and risk factors, a multidisciplinary surgical approach was recommended and planned after consultation with a urologist and a colorectal surgeon. A robotic total abdominal hysterectomy, bilateral salpingo-oophorectomy and pelvic and para-aortic lymph node sampling was planned in combination with a hand assisted laparoscopic right nephrectomy and right transverse colectomy with a stapled ileocolic side to side functional end to end anastomosis as per the surgeons' preferences. The nephrectomy was performed first followed by the colectomy using the same hand assisted access.......

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