Published online Feb 16, 2021. doi: 10.12998/wjcc.v9.i5.1184
Peer-review started: October 29, 2020
First decision: November 20, 2020
Revised: December 2, 2020
Accepted: December 16, 2020
Article in press: December 16, 2020
Published online: February 16, 2021
The diagnosis and etiology of multiple primary malignant neoplasms (MPMNs) are difficult to establish. Here, we report a case of heterochronic triple primary malignancies with gastric cancer, nasopharyngeal squamous cell cancer, and then rectal cancer.
The patient was first diagnosed with gastric cancer at the age of 33 in 2014 and underwent distal gastrectomy and gastrojejunostomy and six cycles of adjuvant chemotherapy. Three years later, he was diagnosed with nasopharyngeal cancer and treated with radical chemoradiotherapy in 2017. Recently, a mass in the middle of the rectum was resected and reported as ulcerative, moderately to poorly differentiated adenocarcinoma. Research on the etiology of MPMNs showed that Epstein-Barr virus (EBV) infection may be the cause of gastric cancer and nasopharyngeal squamous cell cancer since these two primary lesions were positive for transcripts of EBV-encoded ribonucleic acid using an in situ hybridization EBV-encoded ribonucleic acid probe in formalin-fixed, paraffin-embedded tissue. The cause of rectal cancer may be due to a somatic mutation of tumor protein 53 gene in exon 8 (c.844C>T, p.Arg282Trp) through high-throughput sequencing for the rectal cancer. Appropriate standard therapy for each primary cancer was administered, and the patient has no evidence of cancer disease to date.
To our knowledge, this is the first report on heterochronic triple primary malignancies whose cause may be associated with EBV infection and tumor protein 53 genetic mutations. The etiological research may not only elucidate the cause of MPMN but also has implications in clinical management.
Core Tip: The occurrence of triple heterochronic primary malignancies associated with Epstein-Barr virus (EBV) infection and genetic mutations is an extremely rare event. To the best of our knowledge, this is the first case of a 39-year-old male patient with triple heterochronic primary tumors including EBV-associated stomach cancer and nasopharyngeal cancer and tumor protein 53 mutant rectal carcinoma in the literature, and appropriate therapy for each primary cancer led to his good clinical outcome. This case further confirms the value of precision medicine; only a precise diagnosis can lead to appropriate treatment and good prognosis. Further research is needed to elucidate the role of EBV infection and the tumor protein 53 gene in the carcinogenesis of multiple primary malignant neoplasms.