Synchronous primary colorectal mucinous adenocarcinoma and pancreatic ductal adenocarcinoma: A case report

Qiu,Xudong; Qiu,Xudong; Ni,Bo; Ni,Bo; Shen,Yanying; Shen,Yanying; Zhang,Yeqian; Zhang,Yeqian; Xia,Xiang; Xia,Xiang; Cao,Hui; Cao,Hui; Zhang,Zizhen; Zhang,Zizhen; Zhu,Chunchao; Zhu,Chunchao

doi:10.3892/ol.2023.13991

Synchronous primary colorectal mucinous adenocarcinoma and pancreatic ductal adenocarcinoma: A case report

Authors:
- Xudong Qiu
- Bo Ni
- Yanying Shen
- Yeqian Zhang
- Xiang Xia
- Hui Cao
- Zizhen Zhang
- Chunchao Zhu
View Affiliations

Affiliations: Department of Gastrointestinal Surgery, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, P.R. China, Department of Pathology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, P.R. China
Published online on: August 1, 2023 https://doi.org/10.3892/ol.2023.13991
Article Number: 405

Metrics: Total Views: 0 (Spandidos Publications: | PMC Statistics: )

Metrics: Total PDF Downloads: 0 (Spandidos Publications: | PMC Statistics: )

Cited By (CrossRef): 0 citations Loading Articles...

Abstract

The present study reports a rare case of synchronous colorectal mucinous adenocarcinoma (CMAC) and pancreatic ductal adenocarcinoma (PDAC). A 61‑year‑old man complained of hematochezia for half a month. Colonoscopy and biopsy in a local hospital revealed mucinous adenocarcinoma in the sigmoid colon, and a subsequent abdominal computed tomography examination in Ren Ji Hospital (Shanghai, China) identified an unexpectedly hypovascular lesion in the body and tail of the pancreas, in addition to a mass in the colon. The patient then underwent combined surgery consisting of a distal pancreaticosplenectomy and a sigmoidectomy, and the postoperative pathological tests confirmed the co‑occurrence of CMAC and PDAC. Next‑generation sequencing demonstrated no deleterious germline mutations, but did find some critical somatic mutations concerning both tumors. The patient received 12 cycles of a combination of 5‑fluorouracil, leucovorin, irinotecan and oxaliplatin (modified FOLFIRINOX regimen) as adjuvant chemotherapy thereafter. Complete remission was achieved at 1 year after the surgery. To the best of our knowledge, this is the first documented case of such synchronous malignances (CMAC and PDAC) in the literature, and its publication therefore improves our overall understanding in this field.

View Figures

View References

1	Dekker E, Tanis PJ, Vleugels JLA, Kasi PM and Wallace MB: Colorectal cancer. Lancet. 394:1467–1480. 2019. View Article : Google Scholar : PubMed/NCBI
2	Wood LD, Canto MI, Jaffee EM and Simeone DM: Pancreatic cancer: Pathogenesis, screening, diagnosis, and treatment. Gastroenterology. 163:386–402.e1. 2022. View Article : Google Scholar : PubMed/NCBI
3	Park W, Chawla A and O'Reilly EM: Pancreatic cancer: A review. JAMA. 326:851–862. 2021. View Article : Google Scholar : PubMed/NCBI
4	Rahib L, Smith BD, Aizenberg R, Rosenzweig AB, Fleshman JM and Matrisian LM: Projecting cancer incidence and deaths to 2030: The unexpected burden of thyroid, liver, and pancreas cancers in the United States. Cancer Res. 74:2913–2921. 2014. View Article : Google Scholar : PubMed/NCBI
5	Zhai C, Cai Y, Lou F, Liu Z, Xie J, Zhou X, Wang Z, Fang Y, Pan H and Han W: Multiple primary malignant tumors-a clinical analysis of 15,321 patients with malignancies at a single center in China. J Cancer. 9:2795–2801. 2018. View Article : Google Scholar : PubMed/NCBI
6	Warren S: Multiple primary malignant tumors. A survey of the literature and a statistical study. Am J Cancer. 16:1358–1414. 1932.
7	Sakellakis M, Peroukides S, Iconomou G, Boumpoucheropoulos S and Kalofonos H: Multiple primary malignancies: A report of two cases. Chin J Cancer Res. 26:215–218. 2014.PubMed/NCBI
8	Dayer N, Fasquelle F, Salati E and Dietrich G: Multiple primary malignancies: Synchronous lymphoma, pancreatic neuroendocrine tumour and colorectal cancer. BMJ Case Rep. 14:e2419382021. View Article : Google Scholar : PubMed/NCBI
9	Li Destri G, Giarrizzo A, Bellavia N, Milazzotto R, Frattalone ME, Scilletta B and Di Cataldo A: Synchronous double cancers of the colon and the pancreas: A case report. Eur Rev Med Pharmacol Sci. 18:28–31. 2014.PubMed/NCBI
10	Travis LB, Demark Wahnefried W, Allan JM, Wood ME and Ng AK: Aetiology, genetics and prevention of secondary neoplasms in adult cancer survivors. Nat Rev Clin Oncol. 10:289–301. 2013. View Article : Google Scholar : PubMed/NCBI
11	Travis LB, Rabkin CS, Brown LM, Allan JM, Alter BP, Ambrosone CB, Begg CB, Caporaso N, Chanock S, DeMichele A, et al: Cancer survivorship-genetic susceptibility and second primary cancers: Research strategies and recommendations. J Natl Cancer Inst. 98:15–25. 2006. View Article : Google Scholar : PubMed/NCBI
12	Wood ME, Vogel V, Ng A, Foxhall L, Goodwin P and Travis LB: Second malignant neoplasms: Assessment and strategies for risk reduction. J Clin Oncol. 30:3734–3745. 2012. View Article : Google Scholar : PubMed/NCBI
13	Leone G, Pagano L, Ben-Yehuda D and Voso MT: Therapy-related leukemia and myelodysplasia: Susceptibility and incidence. Haematologica. 92:1389–1398. 2007. View Article : Google Scholar : PubMed/NCBI
14	Zhang J, Walsh MF, Wu G, Edmonson MN, Gruber TA, Easton J, Hedges D, Ma X, Zhou X, Yergeau DA, et al: Germline mutations in predisposition genes in pediatric cancer. N Engl J Med. 373:2336–2346. 2015. View Article : Google Scholar : PubMed/NCBI
15	Rahman N: Realizing the promise of cancer predisposition genes. Nature. 505:302–308. 2014. View Article : Google Scholar : PubMed/NCBI
16	Carbone M, Arron ST, Beutler B, Bononi A, Cavenee W, Cleaver JE, Croce CM, D'Andrea A, Foulkes WD, Gaudino G, et al: Tumour predisposition and cancer syndromes as models to study gene-environment interactions. Nat Rev Cancer. 20:533–549. 2020. View Article : Google Scholar : PubMed/NCBI
17	Sinicrope FA: Lynch syndrome-associated colorectal cancer. N Engl J Med. 379:764–773. 2018. View Article : Google Scholar : PubMed/NCBI
18	Martincorena I and Campbell PJ: Somatic mutation in cancer and normal cells. Science. 349:1483–1489. 2015. View Article : Google Scholar : PubMed/NCBI
19	Cancer Genome Atlas Research Network. Electronic address: andrew_aguirre@dfci.harvard.edu, . Cancer Genome Atlas Research Network: Integrated genomic characterization of pancreatic ductal adenocarcinoma. Cancer Cell. 32:185–203.e13. 2017. View Article : Google Scholar : PubMed/NCBI
20	Hayashi A, Hong J and Iacobuzio-Donahue CA: The pancreatic cancer genome revisited. Nat Rev Gastroenterol Hepatol. 18:469–481. 2021. View Article : Google Scholar : PubMed/NCBI
21	JCO Flashback: Predictive value of KRAS mutations on the outcomes of panitumumab monotherapy in colorectal cancer. J Clin Oncol. 41:32772023. View Article : Google Scholar
22	Dy GK, Govindan R, Velcheti V, Falchook GS, Italiano A, Wolf J, Sacher AG, Takahashi T, Ramalingam SS, Dooms C, et al: Long-term outcomes and molecular correlates of sotorasib efficacy in patients with pretreated KRAS G12C-mutated non-small-cell lung cancer: 2-year analysis of CodeBreaK 100. J Clin Oncol. 41:3311–3317. 2023. View Article : Google Scholar : PubMed/NCBI
23	van de Haar J, Ma X, Ooft SN, van der Helm PW, Hoes LR, Mainardi S, Pinato DJ, Sun K, Salvatore L, Tortora G, et al: Codon-specific KRAS mutations predict survival benefit of trifluridine/tipiracil in metastatic colorectal cancer. Nat Med. 29:605–614. 2023. View Article : Google Scholar : PubMed/NCBI
24	Mullard A: The KRAS crowd targets its next cancer mutations. Nat Rev Drug Discov. 22:167–171. 2023. View Article : Google Scholar : PubMed/NCBI
25	Karlsson K, Przybilla MJ, Kotler E, Khan A, Xu H, Karagyozova K, Sockell A, Wong WH, Liu K, Mah A, et al: Deterministic evolution and stringent selection during preneoplasia. Nature. 618:383–393. 2023. View Article : Google Scholar : PubMed/NCBI
26	Frankell AM, Dietzen M, Al Bakir M, Lim EL, Karasaki T, Ward S, Veeriah S, Colliver E, Huebner A, Bunkum A, et al: The evolution of lung cancer and impact of subclonal selection in TRACERx. Nature. 616:525–533. 2023. View Article : Google Scholar : PubMed/NCBI
27	Shen R, Fu D, Dong L, Zhang MC, Shi Q, Shi ZY, Cheng S, Wang L, Xu PP and Zhao WL: Simplified algorithm for genetic subtyping in diffuse large B-cell lymphoma. Signal Transduct Target Ther. 8:1452023. View Article : Google Scholar : PubMed/NCBI
28	Iacopetta B: TP53 mutation in colorectal cancer. Hum Mutat. 21:271–276. 2003. View Article : Google Scholar : PubMed/NCBI
29	Fearon ER: Molecular genetics of colorectal cancer. Ann Rev Pathol. 6:479–507. 2011. View Article : Google Scholar : PubMed/NCBI
30	Aaquist T, Dembic M, Thomassen M, de Stricker K, Bertelsen M, Christensen LG, Mortensen MB and Detlefsen S: Synchronous detection of pancreatic adenocarcinoma and paraganglioma in a Whipple resection specimen. Pathology Res Pract. 226:1535902021. View Article : Google Scholar : PubMed/NCBI
31	Brandler J, Wu TT and Sweetser S: Young onset breast and colon cancer. Gastroenterology. 152:e12–e13. 2017. View Article : Google Scholar : PubMed/NCBI
32	Hirata K, Kanemitsu S, Nakayama Y, Nagata N, Itoh H, Ohnishi H, Ishikawa H and Furukawa Y: A novel germline mutation of MSH2 in a hereditary nonpolyposis colorectal cancer patient with liposarcoma. Am J Gastroenterol. 101:193–196. 2006. View Article : Google Scholar : PubMed/NCBI
33	Ottenhof NA, de Wilde RF, Morsink FH, de Leng WW, Ausems MG, Morreau H, van Hillegersberg R, Offerhaus GJ and Milne AN: Pancreatic ductal adenocarcinoma in hereditary diffuse gastric cancer. A case report. Hum Pathol. 43:457–461. 2012. View Article : Google Scholar : PubMed/NCBI
34	Silvestris N, Zito FA, Fiore MG, Simone G, Tommasi S, Izzi G, Guarini A and Colucci G: Synchronous presentation of B-cell chronic lymphocytic leukemia/small-cell lymphoma and colon adenocarcinoma within the same mesenteric lymph nodes and a single liver metastasis. J Clin Oncol. 29:e11–e13. 2011. View Article : Google Scholar : PubMed/NCBI
35	Hecht SS and Hatsukami DK: Smokeless tobacco and cigarette smoking: Chemical mechanisms and cancer prevention. Nat Rev Cancer. 22:143–155. 2022. View Article : Google Scholar : PubMed/NCBI
36	Boffetta P and Hashibe M: Alcohol and cancer. Lancet Oncol. 7:149–156. 2006. View Article : Google Scholar : PubMed/NCBI
37	Prabhu A, Obi KO and Rubenstein JH: The synergistic effects of alcohol and tobacco consumption on the risk of esophageal squamous cell carcinoma: A meta-analysis. Am J Gastroenterol. 109:822–827. 2014. View Article : Google Scholar : PubMed/NCBI
38	Hugen N, Brown G, Glynne-Jones R, de Wilt JH and Nagtegaal ID: Advances in the care of patients with mucinous colorectal cancer. Nat Rev Clin Oncol. 13:361–369. 2016. View Article : Google Scholar : PubMed/NCBI
39	Luo C, Cen S, Ding G and Wu W: Mucinous colorectal adenocarcinoma: Clinical pathology and treatment options. Cancer Commun (Lond). 39:132019. View Article : Google Scholar : PubMed/NCBI
40	Siegel RL, Miller KD, Fuchs HE and Jemal A: Cancer statistics, 2021. CA Cancer J Clin. 71:7–33. 2021. View Article : Google Scholar : PubMed/NCBI
41	Chu LC, Goggins MG and Fishman EK: Diagnosis and detection of pancreatic cancer. Cancer J. 23:333–342. 2017. View Article : Google Scholar : PubMed/NCBI
42	Mizrahi JD, Surana R, Valle JW and Shroff RT: Pancreatic cancer. Lancet. 395:2008–2020. 2020. View Article : Google Scholar : PubMed/NCBI
43	Su L and Wernberg J: Synchronous distal pancreatic metastatic lesion arising from colonic adenocarcinoma: Case report and literature review. Clin Med Res. 12:166–170. 2014. View Article : Google Scholar : PubMed/NCBI
44	Conroy T, Castan F, Lopez A, Turpin A, Ben Abdelghani M, Wei AC, Mitry E, Biagi JJ, Evesque L, Artru P, et al: Five-year outcomes of FOLFIRINOX vs. gemcitabine as adjuvant therapy for pancreatic cancer: A randomized clinical trial. JAMA Oncol. 8:1571–1578. 2022. View Article : Google Scholar : PubMed/NCBI
45	Conroy T, Hammel P, Hebbar M, Ben Abdelghani M, Wei AC, Raoul JL, Choné L, Francois E, Artru P, Biagi JJ, et al: FOLFIRINOX or gemcitabine as adjuvant therapy for pancreatic cancer. N Engl J Med. 379:2395–2406. 2018. View Article : Google Scholar : PubMed/NCBI