engleski

Four primary unrelated tumors-a case report.

Patient LJ.O. (64) was medically treated in August 2004 for urinary bladder tumor. Transurethral resection of the tumor was done and the cystoscopy results revealed papillary urothelial tumor, located above the right ureter mouth. Histological analysis showed Ca uroteheliale papillare vesicae urinariae. During regular medical check-ups at urologist no signs of recurrent disease were identified. During patient's regular mammography screening in 2008, a lesion was found in the retromammilar part of the left breast, suspected as a malignant tumor. Ultrasound-guided cytological biopsy of the lesion showed signs of malignant cells. Therefore, the patient was referred to surgical clinic where the suspected matter should be removed. In July 2008, the patient was hospitalized for further preoperative diagnostic evaluation. Chest X-ray showed a marked nodular shadow located posterior supradiafragmal in the left lung left supradiafragmal marked shadow located behind, while CT scan showed the same lesion measuring 2.5 x 2 cm. Therefore, tumorectomy of the right breast excluding axillary lymph node dissection was done and the results indicated invasive lobular breast cancer. Before reaching the decision on how to proceed with a treatment, internist oncologist advisory committee considered necessary to clarify whether the lung lesion was solitary metastasis from breast or bladder cancer or a new independent primary tumor. As a result, in October 2008 left thoracotomy was performed and the suspicious lesion was entirely removed. Histological analysis showed that the suspicious lesion was lung carcinoid, i.e. a new primary tumor. Whole-body PET/CT scan was made and results indicated a possible neoplastic process in the rectum. Colonoscopic biopsy and excision of the suspicious matter indicated a tubulovillous adenoma with dysplastic epithelium. Hence, the rectal adenoma would be the fourth primary independent tumor that the patient LJ.O. was diagnosed with. Considering that the bladder, lung and rectum neoplasms have been radically operated the radical surgical treatment of a breast together with axillary dissection should be performed upon this patient. Although examples like this are extremely rare in the clinical practice they should teach us that we should not approach suspicious lesions as if they were metastasis, even if they looked like typical metastasis, without performing histological verification first.

primary unrelated tumors; therapy

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