Multiple primary malignant neoplasm: Case report and comprehensive literature review

Area of Science:

• Oncology
• Genetics
• Clinical Medicine

Background:

• Multiple primary tumors, particularly quadruple malignancies, present a rare clinical challenge with no established management protocols.
• This report details a unique case involving a 79-year-old female diagnosed with four distinct primary cancers: bone tumor, bladder malignancy, malignant melanoma, and intrahepatic cholangiocarcinoma.

Observation:

• The patient had a history of bone tumor surgery 45 years prior and bladder cancer treatment 15 years ago.
• Recent diagnosis included extremity malignant melanoma, intrahepatic cholangiocarcinoma, and multiple lymphadenopathies.
• Next-generation sequencing (NGS) identified a KRAS gene mutation (P.G12V) in the patient's serum.

Findings:

• The patient received systemic therapy (gemcitabine/cisplatin and Camrelizumab) for malignant melanoma and intrahepatic cholangiocarcinoma, achieving stable disease initially.
• Despite treatment, tumor progression occurred, leading to the patient's refusal of further therapy and subsequent death from septic shock.
• The case suggests a potential association between KRAS germline mutations and the development of multiple primary tumors.

Implications:

• Next-generation sequencing (NGS) is crucial for the clinical management of patients with multiple primary tumors.
• Systemic treatment tailored to concurrent primary malignancies is vital for potentially improving patient outcomes.
• Further research into the genetic underpinnings of multiple primary tumors, such as KRAS mutations, is warranted.