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OBJECTIVE: To investigate the prognostic factors for all-cause mortality in patients with muscle-invasive bladder cancer (MIBC) with intermediate-to-high-risk primary prostate cancer. METHODS: From January 2012 to October 2023, the clinical data of the patients with MIBC with intermediate-to-high-risk primary prostate cancer in Peking University Third Hospital were retrospectively analyzed. All the patients were monitored and the occurrence of all-cause death was documented as the outcome event in the prognostic study. Univariate and multivariate Cox proportional risk regression analysis models were implemented to search for independent influences on the prognosis of patients. For significant influencing factors (pathological T stage, M stage and perineural invasion of bladder cancer), survival curves were plotted before and after multifactorial Cox regression adjusting for confounding factors. RESULTS: A total of 32 patients were included in this study. The mean age was (72.5±6.6) years; the median preoperative total prostate specific antigen (tPSA) was 6.68 (2.47, 6.84) µg/L; the mean preoperative creatinine was (95±36) µmol/L, and the median survival time was 65 months. The majority of the patients (87.5%) had high-grade bladder cancer, 53.1% had lymphatic invasion, and 31.3% had perineural invasion. Prostate involvement was observed in 25.0% of the cases, and the positive rate of soft-tissue surgical margin was 37.5%. Multivariate Cox analysis revealed that preoperative creatinine level (HR=1.02, 95%CI: 1.01-1.04), pathological stage of bladder cancer T3 (HR=11.58, 95%CI: 1.38-97.36) and T4 (HR=19.53, 95%CI: 4.26-89.52) metastasis of bladder cancer (HR=9.44, 95%CI: 1.26-70.49) and perineural invasion of bladder cancer (HR=6.26, 95%CI: 1.39-28.27) were independent prognostic factors (P < 0.05). Survival curves with Log-rank test after adjusting for confounding factors demonstrated that bladder cancer pathology T3, T4, M1, and perineural invasion were unfavorable factors affecting the patients' survival prognosis (P < 0.05). CONCLUSION: Patients with MIBC with intermediate-to-high risk primary prostate cancer generally portends a poor prognosis. High preoperative serum creatinine, T3 or T4 pathological stage of bladder cancer, metastasis of bladder cancer and bladder cancer perineural invasion are poor prognostic factors for patients with MIBC with intermediate-to-high risk primary prostate cancer.

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El cáncer gástrico (CG), es la primera causa de muerte por cáncer, en hombres, y la tercera en mujeres, en Chile. No obstante ello, el CG bifocal (CGB) es una situación poco frecuente. El objetivo de este manuscrito fue reportar un caso de CGB, con linfonodos negativos en un paciente con cirrosis hepática, que fue intervenido quirúrgicamente; y revisar la evidencia existente respecto de sus características morfológicas, terapéuticas y pronósticas. Caso clínico: Hombre de 74 años diabético, hipertenso, insuficiente cardíaco y cirrótico; portador de CGB (subcardial y antro-pilórico), diagnosticado por endoscopia y con confirmación histológica de ambas lesiones; operado en Clínica RedSalud Mayor Temuco en septiembre de 2023. En el intraoperatorio se verificó además la coexistencia de una lesión de aspecto metastásico en el segmento III del hígado, y adhesión de la región antro-pilórica a la vesícula biliar. Se realizó gastrectomía total, linfadenectomía D2, esófago-yeyuno anastomosis término-lateral, resección segmentaria hepática (segmento III) y colecistectomía. El paciente permaneció 6 días en la UCI debido a que desarrolló insuficiencia hepática (encefalopatía leve y ascitis). Se alimentó vía enteral por sonda naso-yeyunal. Posteriormente inició alimentación oral progresiva, la que fue bien tolerada. Completó 11 días de hospitalización en servicio médico-quirúrgico, donde mejoró actividad neurológica, hasta su alta domiciliaria. Actualmente, lleva dos meses desde su operación, se encuentra en buenas condiciones generales, y el Comité Oncológico decidió no dar quimioterapia adyuvante. Se presenta un caso inusual de CG de tipo bifocal, respecto de lo cual hay escasa información disponible. Se logró realizar cirugía con intención curativa en un paciente de alto riesgo, con un resultado exitoso.

SUMMARY: Gastric cancer (GC) is the first cause of death from cancer in men, and the third one in women, in Chile. However, a bifocal GC (BGC) is uncommon. The aim of this study was to report a case of CGB, with negative-lymph nodes in a patient with liver cirrhosis, who underwent surgery; and review the existing evidence regarding its morphological, therapeutic and prognostic characteristics. Clinical case: A 74-year-old male patient with a medical history of diabetes, hypertension, congestive heart failure, and cirrhosis underwent surgical intervention for GC located in subcardial and antro- pyloric regions. The diagnosis was established via endoscopy and confirmed histologically. Surgery was performed at the RedSalud Mayor Temuco Clinic in September 2023. During intraoperative assessment, the coexistence of a lesion with metastatic-like characteristics in segment III of the liver was also verified, along with adhesions between the antro-pyloric region and the gallbladder. Surgical approach encompassed total gastrectomy, D2 lymphadenectomy, esophago-jejunostomy, segmental hepatic resection, and cholecystectomy. Subsequently, the patient required a six-day stay in ICU due to the development of hepatic insufficiency, characterized by mild encephalopathy and ascites. Enteral nutrition was administered via a naso-jejunal tube, followed by a gradual transition to oral feeding, which was well-tolerated. The patient completed an 11-day hospitalization period in the medical-surgical ward, during which his neurological function improved significantly, resulting in his discharge. At present, 2 months post-surgery, the patient remains in satisfactory general health, and the Oncology Committee decided not to proceed with adjuvant chemotherapy. This case represents a rare instance of bifocal GC, for which there is limited available literature. Surgical intervention with curative intent was successfully carried out in a high-risk patient, yielding a positive outcome.

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Objective:To explore the clinical efficacy of simultaneous or staged video-assisted thoracoscopic surgery (VATS) anatomic segmentectomy for bilateral double primary lung cancer (DPLC).Methods:A retrospective cohort study was conducted. The clinical data of 76 patients with bilateral DPLC who underwent VATS anatomic segmentectomy in Luzhou Traditional Chinese Medicine Hospital from February 2020 to August 2022 were retrospectively analyzed, and they were classified into the simultaneous bilateral thoracoscopic surgery group (the simultaneous group, 44 cases) and the staged thoracoscopic surgery group (the staged group, 32 cases) on the basis of the surgical methods. The intraoperative conditions, perioperative indexes and postoperative complications of the two groups were compared.Results:There were no statistically significant differences in the gender, age, pathological type,postoperative TNM staging of both groups (all P > 0.05). The anesthesia awakening time of the first and second stages of surgery in the staged group was (11±3) min and (13±4) min, which was shorter than that in the simultaneous group [(16±4) min] ( t values were 5.27 and 3.51, both P < 0.05). The number of drainage tubes placed in the simultaneous group was less than that in the sum of two stages of the staged group [(1.9±0.5) tubes vs. (2.2±0.5) tubes, t = 3.40, P = 0.001]. The duration of thoracic drainage tube retention, the postoperative total drainage flow, the days of hospitalization, the first postoperative landing time, and the total treatment cost in the first and second stages of surgery in the staged group were lower than those in the simultaneous group (all P < 0.05), while the postoperative total drainage flow, the days of hospitalization, and the total treatment cost in the sum of two stages of the staged group were higher than those in the simultaneous group (all P < 0.05). The total incidence of complications in the simultaneous group was higher than that in the staged group 1 month after surgery [18.18% (8/44) vs. 3.13% (1/32)], and the difference was statistically significant ( χ2 = 4.02, P = 0.045). The scores of activities of daily living, arterial partial pressure of oxygen, arterial partial pressure of carbon dioxide, and blood oxygen saturation in the simultaneous group were lower than those in the staged group (all P < 0.05). Conclusions:Staged VATS anatomic segmentectomy for bilateral DPLC has few complications and good ability to perform activities of daily living, whereas the treatment cost of simultaneous bilateral thoracoscopic surgery is low. Clinicians may recommend prioritizing simultaneous bilateral thoracoscopic surgery after comprehensively considering the patients ' physical and economic conditions.

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Objective:To explore the prognostic factors and the relationship between the disease type at initial diagnosis and the disease type causing death in patients with laryngeal cancer combined with simultaneous lung cancer.Methods:The clinicopathological data of 240 patients diagnosed with laryngeal cancer combined with simultaneous lung cancer between January 2004 and December 2015 in the Surveillance, Epidemiology and End Results (SEER) database were retrospectively analyzed. Chi-square test was used to evaluate the relationship between the disease type at initial diagnosis and the disease type causing death in patients with laryngeal cancer combined with simultaneous lung cancer. Kaplan-Meier method was used for survival analysis, and Cox proportional risk model was used to make univariate and multivariate analysis of the factors influencing the overall survival of patients.Results:A total of 240 cases with laryngeal cancer combined with simultaneous lung cancer included 222 males and 18 females, and there were 141 cases aged over 65 years. The disease type at initial diagnosis was not correlated with the disease type causing death of patients ( χ2 = 3.31, P = 0.191). The 1-year, 3-year, and 5-year overall survival rates of these patients were 62.1%, 31.5%, and 16.4%, respectively. Univariate analysis showed that the primary location of laryngeal cancer, primary location of lung cancer, histological grade of lung cancer, pathological type, clinical staging, surgical condition, and radiotherapy influenced the overall survival of patients (all P < 0.05); multivariate analysis showed that the primary location of laryngeal cancer, primary location of lung cancer, histological grade of lung cancer, pathological type, clinical stage, and surgical condition were independent influencing factors for overall survival of patients with laryngeal cancer combined with simultaneous lung cancer (all P < 0.05). Conclusions:The independent factors influencing the prognosis of laryngeal cancer with simultaneous lung cancer patients include the primary focus of laryngeal cancer, the primary focus of lung cancer, the histological grade of lung cancer, the pathological type, the clinical stage, and the surgical condition. And there is no correlation between the disease type at initial diagnosis and the disease type causing death.

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Objective:To explore the clinical features and prognosis of simultaneous double primary and single primary colorectal cancer patients.Methods:A retrospective case series study was conducted. The clinical data of 45 patients with simultaneous double primary colorectal cancer, 53 patients with single primary colon cancer and 59 patients with single primary rectal cancer in Shanxi Province Cancer Hospital from January 2015 to January 2018 were retrospectively analyzed, including gender, age, drinking history, smoking history, body mass index (BMI), carcinoembryonic antigen (CEA), carbohydrate antigen 199 (CA199), hemoglobin, albumin, TNM stage. The clinicopathological characteristics of the three groups were compared. Survival analysis was performed using the Kaplan-Meier method to compare the overall survival of the three groups.Results:The age of simultaneous double primary colorectal cancer patients was (63±11) years old, including 28 males and 17 females; the age of single primary colon cancer patients was (61±12) years old, including 30 males and 23 females; the age of single primary rectal cancer patients was (60±11) years old, including 30 males and 29 females. There was a significant difference in BMI between patients with double primary cancer and single primary colon cancer ( P = 0.041), but there were no significant differences in gender, age, drinking history, smoking history, CEA, CA199, hemoglobin, albumin and TNM stage (all P > 0.05). There were significant differences in BMI, CEA and CA199 between patients with double primary cancer and single primary rectal cancer (all P < 0.05), but there were no significant differences in gender, age, drinking history, smoking history, hemoglobin, albumin and TNM stage (all P > 0.05). The 1-, 3- and 5-year overall survival rates of the double primary cancer patients were 95.56%, 77.78% and 62.22%, the single primary colon cancer patients were 94.34%, 81.13% and 69.81%, and the single primary rectal cancer patients were 100.00%, 88.14% and 72.88%, respectively. There was no significant difference in OS among patients with double primary cancer, single primary rectal cancer and single primary rectal cancer (both P > 0.05). Conclusions:Abnormally elevated BMI may be associated with the risk of developing simultaneous double primary colorectal cancer. Detection of CEA and CA199 is helpful in monitoring rectal cancer patients for the combination of other primary tumors. The prognosis of patients with single primary colon or rectal cancer is comparable to that of patients with simultaneous double primary colorectal cancer.

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OBJECTIVE: To investigate the treatment and prognosis of multiple primary malignant neoplasms (MPMN) complicated with renal cell carcinoma (RCC), and to make risk stratification. METHODS: A retrospective study of 27 cases of MPMN with RCC in two centers, including the different tumors of MPMN, specific treatment methods, and the interval between primary cancers. At the same time, the survival conditions, including recurrence, metastasis and survival, were followed up for statistical analysis. The interval between the two kinds of primary cancer within 6 months was simultaneous MPMNs, and more than 6 months was metachronous MPMNs. For simple risk stratification of cases, as long as one of the MPMNs had a stage Ⅲ or higher malignancy, which was defined as high risk. RESULTS: Among the 27 patients, 20 were male and 7 were female, with age at the time of diagnosis was 42-82 years, with an average age of (61.3±11.7) years. The age at the diagnosis of renal cancer was 43-87 years, with an average age of (66.0±11.3) years. There were 21 cases with duplex primary malignant neoplasms, 4 cases with triple primary malignant neoplasms, and 2 cases with quadruple primary malignant neoplasms. The interval between first cancer and second cancer was 0-360 months, with a median of 18 months. There were 17 cases of metachronous multiple primary malignant neoplasms and 10 cases of simultaneous multiple primary malignant neoplasms. The most common system of MPMN with comorbid RCC involved urologic system, digestive system and respiratory system. The most common locations of MPMN with comorbid RCC were bladder cancer, lung cancer and colon cancer. Follow-up time calcu- lated from the last cancer was 2-156 months, with a median of 32 months. And 14 cases survived and 13 cases died, with 11 cases being tumor related. Tumor stage was the risk factor of prognosis. Any kind of tumor stage in stage Ⅲ or above had a relatively poor prognosis. CONCLUSION: MPMN complicated with RCC is relatively rare. Standard treatment should be used for each cancer type during the treatment process. The prognosis mainly depends on the highest stage of each tumor. Simple risk stratification shows that the prognosis of the high-risk group is worse. This simple stratification method may be helpful to predict the prognosis.

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Multicentric cancer of the pectoral and ectopic breasts is extremely rare, and diagnosing this malignancy remains challenging because axillary breast cancer is easily misdiagnosed as lymph node metastasis. Moreover, there are no established treatment guidelines for this disease. We present our experience with a multicentric breast cancer patient who showed different responses to neoadjuvant chemotherapy (NAC) and underwent surgical treatments that differed from those in previous studies. In our case, the preoperative imaging of both lesions and subsequent core needle biopsy of each lesion were crucial, as these procedures confirm the diagnosis and help decide the chemotherapy regimen based on the subtype. After NAC, the patient underwent right breast-conserving surgery, sentinel lymph node biopsy (SLNB), and excision of accessory breast tissue in the right axilla. SLNB should be the initial step in staging multicentric breast cancer, unless imaging scan shows evidence of lymph node metastasis.

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AIM: This study was performed to evaluate patterns of breast cancer subtypes in Korean patients with synchronous (SBC) or metachronous bilateral breast cancer (MBC). METHODS: We retrospectively reviewed records of 302 patients with SBC (n = 161) or MBC (n = 141) who received curative surgery at our hospital between 1995 and 2013. Expression of estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER2) was determined by immunohistochemistry (IHC) staining. We categorized breast cancers into the following subtypes: ER+ or PR+, HER2- (i.e., luminalA); ER+ or PR+, HER2+ (i.e., luminalB HER2+); ER-, PR- and HER2+ (i.e., HER2-enriched); ER-, PR- and HER2- (i.e., triple negative, TN). RESULTS: More patients with MBC were ≤40 years at the time of breast cancer diagnosis than patients with SBC (34.6% vs. 19.3%, P < 0.01). The proportion of subtypes in SBC and MBC were as follows: luminalA, 65.8% vs. 45.0%; luminalB, HER2+, 9.0% vs. 8.5%; HER2-enriched, 4.1% vs. 12.1%; and TN, 11.2% vs. 31.2%, respectively (P < 0.01). The 10-year overall survival rate in patients with SBC and MBC was 89.0% and 93.6%, respectively. The 10-year disease-free survival rate in patients with SBC and MBC was 79.6% and 80.9%, respectively. Locoregional recurrence was found in 2.5% of patients with SBC and 9.9% of patients with MBC. Distant metastasis occurred in 8.7% of patients with SBC and 4.9% of patients with MBC. CONCLUSION: The distribution of breast cancer subtypes was different between SBC and MBC. TN-subtype was profoundly more frequent in MBC whereas luminal-subtype was most frequently found among SBC.

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Objective:To investigate the clinicopathological features, diagnosis, treatment and prognosis of simultaneous double primary gynecological malignant tumors.Methods:A total of 23 patients with simultaneous double primary malignant tumors of female reproductive system primarily treated in Beijing Obstetrics and Gynecology Hospital, Capital Medical University from January 1, 2010 to December 31, 2020 were retrospectively collected. The age, symptoms, tumor stage, tumor type, treatment and prognosis of patients were collected and followed up.Results:(1) The number of patients with gynecological tumors in our hospital increased year by year in the past 11 years. A total of 8 987 patients with gynecological malignant tumors were firstly diagnosed and cured in our hospital, including 3 474 cases of cervical cancer, 3 484 cases of endometrial cancer, 1 329 cases of ovarian malignancies, 171 cases of fallopian tube cancer, 182 cases of uterine sarcoma, 42 cases of vaginal cancer, 192 cases of vulvar cancer, 110 cases of trophoblastic tumor and 3 cases of other gynecological malignancies. The top three cancers were endometrial cancer, cervical cancer and ovarian malignancies. (2) There were 23 patients identified with simultaneous double primary gynecological tumors in the past 11 years, accounting for 0.26% (23/8 987) of female malignant tumors. There were 3 cases of cervical cancer complicated with endometrial cancer, 3 cases of cervical cancer complicated with ovarian cancer, 16 cases of endometrial cancer combined with ovarian cancer, and 1 patient with endometrial cancer combined with fallopian tube cancer. (3) All 23 patients underwent surgical treatment. According to the first diagnosis of the tumor, the surgical methods included cervical cancer radical surgery, endometrial cancer staging surgery and ovarian cancer cytoreductive surgery. After operation, radiotherapy and chemotherapy were supplemented according to the results of pathological examination and tumor staging. (4) The age of 23 patients ranged from 28 to 66 years, with an average age of (49.4±9.7) years. All patients had vaginal bleeding or conscious pelvic mass as their main clinical manifestation. The clinical stage was found in 7 patients (30%, 7/23) with advanced gynecological cancer (stage Ⅲ-Ⅳ), and 16 patients (70%, 16/23) with early stage gynecological cancer (stage Ⅰ-Ⅱ). According to the nonspecific tumor markers, 13 patients (57%, 13/23) had elevated CA 125 and CA 199. (5) Among the 23 patients, 1 case was uncontrolled and 3 cases recurred during the follow-up period, and the sites of uncontrolled or recurred were all located in the abdominopelvic cavity. Three cases died. Among the 3 patients who died, 1 patient was an uncontrolled patient, whose tumor type was cervical adenosquamous cell carcinoma combined with ovarian clear cell adenocarcinoma. The overall survival time was 19 months with postoperative supplementary radiotherapy and chemotherapy. There were 2 recurrent patients, and the tumor types were endometrioid carcinoma complicated with high-grade serous ovarian carcinoma and ovarian endometrioid carcinoma, respectively. After surgery, all patients received supplementary chemotherapy and recurred 60 and 21 months after surgery, respectively, and the overall survival time was 78 and 28 months, respectively. Another patient recurred 43 months after surgery, and survived with tumor for 14 months after recurrence. The remaining 19 patients were tumor-free and were still being followed up. Conclusions:There are no specific markers for simultaneous double primary gynecological malignant tumors. The most common clinical symptoms are vaginal bleeding or pelvic mass. The treatment principle of simultaneous double primary gynecological malignant tumor is the same as that of single gynecological malignant tumor, but need to be taken into account the characteristics of two tumors. Surgery is the main treatment method, and radiotherapy and chemotherapy play an important auxiliary role. The prognosis of simultaneous double primary gynecological malignancies is related to the late stage of the two malignancies.

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OBJECTIVE: To investigate the endoscopic and pathological characteristics of gastric adenomatous polyps and to assess the potential risk factors for canceration of gastric adenomatous polyps. METHODS: The endoscopic and pathological characteristics of the patients with gastric adenomatous polyps from January 1, 2005 to December 31, 2019 were summarized retrospectively, and the risk factors of canceration were analyzed. RESULTS: A total of 125 patients with gastric adenomatous polyps were included, 51.20% of whom were females. The average age was (66.7±12.3) years. 64.80% of patients with gastric adenomatous polyps equal or more than 65 years old, and only 5.60% of the patients less than 45 years old. Adenomatous polyps were mostly distributed in the corpus and antrum with 40.80% and 32.80%, respectively. The majority of them were single (90.40%) and sessile (76.81%). 65.4% of adenomatous polyps were no more than 1.0 cm in diameter, and 23.20% of patients with adenomatous polyps were combined with hyperplastic polyps and/or fundus glandular polyps, and 1.60% had both pathological types of polyps. 58.62% (17/29) patients with hyperplastic polyps and/or fundus glandular polyps had multiple polyps. 1.60% (2/125) of the patients had gastric neuroendocrine tumor of G1 stage. Synchronous gastric cancer was detected in 13.60% (17/125) of the patients with adenomatous polyps, and the proportion of low-grade intraepithelial neoplasia was 18.40% (23/125). The main types of synchronous gastric cancer were progressive (70.59%) and undifferentiated (66.67%). Chronic atrophic gastritis with intestinal metaplasia was found in 52.80% of the patients, and autoimmune gastritis accounted for 11.20%. The positive rate of Helicobacter pylori was 21.60%. The canceration rate of gastric adenomatous polyps was 20.80%. The cancer was mainly differentiated, but there was sigmoid ring cell carcinoma as well. Diameter of >1.0 cm (OR=5.092, 95%CI: 1.447-17.923, P=0.011), uneven surface morphology and erosion (OR=13.749, 95%CI: 1.072-176.339, P=0.044) were independent risk factors of adenomatous polyps. CONCLUSION: The synchronous gastric cancer is common and the canceration of gastric adenomatous polyps is high with diameter and surface morphology as independent risk factors. We should pay attention to the identification of the pathological types of polyps and the evaluation of the whole gastric mucosa during the endoscopic examination.

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OBJECTIVE@#To investigate the endoscopic and pathological characteristics of gastric adenomatous polyps and to assess the potential risk factors for canceration of gastric adenomatous polyps.@*METHODS@#The endoscopic and pathological characteristics of the patients with gastric adenomatous polyps from January 1, 2005 to December 31, 2019 were summarized retrospectively, and the risk factors of canceration were analyzed.@*RESULTS@#A total of 125 patients with gastric adenomatous polyps were included, 51.20% of whom were females. The average age was (66.7±12.3) years. 64.80% of patients with gastric adenomatous polyps equal or more than 65 years old, and only 5.60% of the patients less than 45 years old. Adenomatous polyps were mostly distributed in the corpus and antrum with 40.80% and 32.80%, respectively. The majority of them were single (90.40%) and sessile (76.81%). 65.4% of adenomatous polyps were no more than 1.0 cm in diameter, and 23.20% of patients with adenomatous polyps were combined with hyperplastic polyps and/or fundus glandular polyps, and 1.60% had both pathological types of polyps. 58.62% (17/29) patients with hyperplastic polyps and/or fundus glandular polyps had multiple polyps. 1.60% (2/125) of the patients had gastric neuroendocrine tumor of G1 stage. Synchronous gastric cancer was detected in 13.60% (17/125) of the patients with adenomatous polyps, and the proportion of low-grade intraepithelial neoplasia was 18.40% (23/125). The main types of synchronous gastric cancer were progressive (70.59%) and undifferentiated (66.67%). Chronic atrophic gastritis with intestinal metaplasia was found in 52.80% of the patients, and autoimmune gastritis accounted for 11.20%. The positive rate of Helicobacter pylori was 21.60%. The canceration rate of gastric adenomatous polyps was 20.80%. The cancer was mainly differentiated, but there was sigmoid ring cell carcinoma as well. Diameter of >1.0 cm (OR=5.092, 95%CI: 1.447-17.923, P=0.011), uneven surface morphology and erosion (OR=13.749, 95%CI: 1.072-176.339, P=0.044) were independent risk factors of adenomatous polyps.@*CONCLUSION@#The synchronous gastric cancer is common and the canceration of gastric adenomatous polyps is high with diameter and surface morphology as independent risk factors. We should pay attention to the identification of the pathological types of polyps and the evaluation of the whole gastric mucosa during the endoscopic examination.

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Objective:To compare the clinicopathological characteristics of main and accessory lesions in patients with synchronous multiple esophageal lesions (SMEL, i. e. early esophageal cancer and intraepithelial neoplasia) and to explore their correlation.Methods:Data of 80 patients with SMEL treated by endoscopic resection in The First Medical Center of Chinese PLA General Hospital from November 2006 to September 2019 were retrospectively analyzed, and the clinicopathological characteristics as well. The lesions were divided into main and accessory lesions, and their correlation in macroscopic type, lesion location, pathological type and invasion depth in 70 patients with double SMEL were investigated.Results:The age of 80 patients with SMEL was 61.3±8.32 years, more common in males (83.8%, 67/80). Fifty-seven patients (71.2%) had a history of smoking and drinking, respectively. There was a positive correlation between the size of main and accessory lesions in the 70 patients with double SMEL ( r=0.464, P<0.001). The macroscopic type ( P=0.115), location ( P=0.340) and depth of invasion ( P=0.555) of the main and accessory lesions were not correlated, but the pathological type had high correlation ( P<0.001). The consistency rate was 50.0% (35/70). Conclusion:Most SMEL patients are elderly males with a history of smoking and drinking. When one lesion is found, there is high possibility of multiple lesions. Physicians should be aware of the correlation between main and accessory lesions to avoid missed diagnosis.

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The rearrangement of the gene encoding the transcription factor ETS-related gene (ERG) is thought to play a key role in the development of prostate cancer. However, the studies on the ERG mutations have been rarely reported in non-small cell lung carcinoma (NSCLC). Here, we reported genetic features regarding a case of a 68-year-old male patient who presented the primary synchronous multiple tumor lesions in the separated lungs. The patient was hospitalized due to the presence of tumor lesions at the right and left lungs revealed by a chest computerized tomography (CT) scan. After conducting lobectomies at the both lungs, the tumor nodules were all removed, and the histological analysis suggested adenocarcinoma at the both tumor lesions. The patient was diagnosed with synchronous multiple primary lung cancer (SMPLC) based on Martini-Melamed criteria and American College of Chest Physicians practice guidelines. An exome analysis of 315 genes in the two tumor lesions and a non-tumor lesion was conducted by using Illumina Nextseq500 platform from each tumor region to decipher a potential evolutional progress of SMPLC. Single or pair-end reads were first mapped to a human genome reference and filtered based on the mapping quality score. The read depth was ≥ 1 000× and the depth of coverage was 95%. The data revealed a discordant epidermal growth factor receptor (EGFR) from the separate lungs; additionally, a high frequency of point mutation on exon 9 H310P of the ERG gene was detected at the both sites of the tumor lesions. This case showed that a potential role of the molecular features analysis from each tumor lesion might contribute to the understanding of the evolutional development of SMPLC. This study suggests that the same environment may contribute certain gene(s) mutations in the same sites in the early stages of polyclonal tumor origins; meanwhile the extensive studies on these genes may help us understand the evolution and progress of tumor clones.

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Multiple primary malignancies are defined as the presence of more than one malignant neoplasm with a distinct histology occurring at different sites in the same individual. They are classified as synchronous or metachronous according to the diagnostic time interval of different malignancies. Diagnosis of multiple primary malignancies should avoid misclassification from multifocal/multicentric tumors or recurrent/metastatic lesions. In multiple primary malignancies, with increase in the number of primary tumors, the frequency rapidly decreases. Here, we report an exceptionally rare case of a woman who was diagnosed with metachronous sporadic sextuple primary malignancies including bilateral breast cancers (gastric cancer, ovarian Sertoli-Leydig cell tumor, left breast cancer, thyroid cancer, right breast cancer, and rectal neuroendocrine tumor). The sextuple primary malignancies in this case involved 5 different organs: the stomach, ovary, thyroid, rectum, and bilateral breasts. Further studies are needed to elucidate the current epidemiologic status of patients with multiple primary malignancies.

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Hypopharyngeal cancer and esophageal cancer often occur synchronously or metachronously. Timely screening, diagnosis and individual treatment are important to improve the prognosis of patients. At present, there is no clinical guideline or consensus in this cross-cutting area in China, and there is a need of consistent diagnosis and treatment recommendation for these patients. Under the sponsorship of the Committee of Esophageal Cancer in China Anti-Cancer Association, the Chinese Working Group on Cooperative Diagnosis and Treatment of Hypopharyngeal and Esophageal Cancer was established by domestic experts in the fields of otolaryngology head and neck surgery, radiation oncology, and gastrointestinal endoscopy. This consensus document on multiple primary cancers (simultaneous or metachronous) of the hypopharynx and esophagus was developed through literature review, collective experience and expert discussions. The goals of the consensus include: (1) raising concern for this cross-cutting field; (2) establishing a preliminary clinical diagnosis and treatment recommendation; (3) preparing for the establishment of future high-level guidelines through standardized clinical practice.

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Objective: To study the clinicopathologic characteristics and relevant factors affecting prognosis of patients with synchronous bilateral breast cancer. Methods: The clinical data, pathologic characteristics and immunohistochemical expression characteristics of 151 patients with synchronous bilateral breast cancers diagnosed in Peking Union Medical College Hospital from 2008 to 2018 were collected and analyzed. The factors affecting the prognosis were analyzed by Log rank test, Kaplan-Meier survival analysis, Cox regression and other methods. Results: Synchronous bilateral breast cancer cases accounted for 1.2% (151/12 239) of all breast cancer patients in the same period, and 14.6% (22/151) had a family history. The patients' age range was 22-88 years, mainly female, with a mean survival of 42.5 months. There were 106 patients with synchronous bilateral invasive breast cancers, 6 patients with synchronous bilateral breast cancer in situ, and 39 patients with unilateral invasive breast cancer and unilateral breast cancer in situ. In synchronous bilateral invasive breast cancers, the histological type was mainly non-specific type (84.9%, 180/212), the histological grade was mainly Grade 2 (60.8%,129/212), the TNM stage was mainly stage Ⅰ (50.5%, 107/212), the tumor size was mainly T1 (68.9%, 146/212), and the regional lymph node was mainly N0 (61.8%, 131/212). The molecular subtypes were mainly Luminal A-like (38.1%, 75/197) and Luminal B-like (43.7%, 86/197); ER (78.2%, 154/197) and PR (72.1%,142/197)were mainly positive, and HER2 was mainly negative (91.9%, 181/197). There were 85 (80.2%) patients and 75 (70.8%) patients with the same histological type and histological grade on both sides, respectively. The concordance of tumor size T stage and the regional lymph nodes N stage were 58.5% (62/106) and 55.7% (59/106), respectively. The concordance of molecular subtype was 54.9% (50/91), and the concordance of ER, PR, HER2 and Ki-67 were 83.5% (76/91), 76.9% (70/91), 89.0% (81/91) and 59.3% (54/91), respectively. The expression of ER and PR in synchronous bilateral invasive breast cancer was significantly correlated with prognosis (P<0.05). Conclusions: Among patients with synchronous bilateral breast cancers, bilateral invasive breast cancer is the most common, the prognosis is the worst, and the pathologic characteristics of bilateral breast cancer tend to be consistent. The expression of ER and PR in synchronous bilateral invasive breast cancer is significantly correlated with prognosis, that is, best for bilateral ER-positive patients, worst for bilateral ER-negative patients, and intermediate for unilateral ER-positive patients, thus suggesting the importance of ER and PR detection in synchronous bilateral invasive breast cancers.

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•A cul-de-sac endometrioid carcinoma adjacent to extraovarian endometriosis was identified during remission of endometrial cancer.•The origin of the cul-de-sac tumor was malignant transformation of deep infiltrating endometriosis.•Endometriosis-related cancer was identified in a woman with endometrial cancer during remission.•Hyperestrogenism due to infertility treatment may contribute to malignant transformation of deep infiltrating endometriosis.

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The rearrangement of the gene encoding the transcription factor ETS-related gene (ERG) is thought to play a key role in the development of prostate cancer. However, the studies on the ERG mutations have been rarely reported in non-small cell lung carcinoma (NSCLC). Here, we reported genetic features regarding a case of a 68-year-old male patient who presented the primary synchronous multiple tumor lesions in the separated lungs. The patient was hospitalized due to the presence of tumor lesions at the right and left lungs revealed by a chest computerized tomography (CT) scan. After conducting lobectomies at the both lungs, the tumor nodules were all removed, and the histological analysis suggested adenocarcinoma at the both tumor lesions. The patient was diagnosed with synchronous multiple primary lung cancer (SMPLC) based on Martini-Melamed criteria and American College of Chest Physicians practice guidelines. An exome analysis of 315 genes in the two tumor lesions and a non-tumor lesion was conducted by using Illumina Nextseq500 platform from each tumor region to decipher a potential evolutional progress of SMPLC. Single or pair-end reads were first mapped to a human genome reference and filtered based on the mapping quality score. The read depth was ≥ 1 000× and the depth of coverage was 95%. The data revealed a discordant epidermal growth factor receptor (EGFR) from the separate lungs; additionally, a high frequency of point mutation on exon 9 H310P of the ERG gene was detected at the both sites of the tumor lesions. This case showed that a potential role of the molecular features analysis from each tumor lesion might contribute to the understanding of the evolutional development of SMPLC. This study suggests that the same environment may contribute certain gene(s) mutations in the same sites in the early stages of polyclonal tumor origins; meanwhile the extensive studies on these genes may help us understand the evolution and progress of tumor clones.

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Background: With the development of endoscopic diagnosis technology, the detection rate of multiple primary gastric cancer is increasing. Aims: To explore the efficacy and safety of endoscopic submucosal dissection (ESD) in the treatment of synchronous multiple primary early gastric cancer (SMPEGC). Methods: Fifteen consecutive patients with SMPEGC treated with ESD from March 2018 to December 2019 at the First Affiliated Hospital of Zhejiang Chinese Medical University were collected. Clinical features and outcomes were retrospectively analyzed. The risk of lymph node metastasis was evaluated according to the eCura system. Results: In 15 patients, 32 lesions were resected and 31 specimens were obtained. Thirteen patients underwent simultaneous resection of multiple primary gastric lesions, and 2 patients underwent staged resection. The operation time of ESD was (138.80±58.06) minutes, the length of hospital stay was (11.47±4.63) days, the lesion diameter was (1.30±1.15) cm, the en bloc resection rate was 100% and the curative resection rate was 71.9%. Postoperative complications occurred in 2 patients. According to the eCura system, the risk of lymph node metastasis was low in the 4 patients with non-curative resection. Three months after the operation, no local residual or recurrence was found in 10 patients. Conclusions: ESD is a feasible choice for the treatment of SMPEGC. The length of hospital stay and overall medical costs can be reduced by resection multiple lesions in one operation. For patients with risk factors of complications, one-time surgical resection should be avoided. The risk of lymph node metastasis is not the same for all the patients with non-curative resection. Maybe the eCura system can better evaluate the risk of lymph node metastasis and provide individualized treatment strategy.