Heterochronic triple primary malignancies with Epstein-Barr virus infection and tumor protein 53 gene mutation: A case report and review of literature

Figure 1 Histopathological and immunohistochemical staining of gastric cancer. A: Poorly differentiated carcinoma in the distal stomach with lymphoid interstitial carcinoma; B: Positive staining for Epstein-Barr virus-encoded ribonucleic acid.

Figure 2 Histopathological and immunohistochemical staining of nasopharyngeal cancer. A: Poorly differentiated squamous cell carcinoma of the nasopharynx by pathology of nasal endoscopic biopsy; B: Positive staining for Epstein-Barr virus-encoded RNA.

Figure 3 Axial computed tomography images reveal a rectal mass. A: Axial maximum intensive projection at the same imaging level, and coronal images showed a 40 mm solitary nodule approximately 58 mm away above the anus in the rectum; B: Axial images of positron emission topography-computed tomography at the same imaging level, and rectal image of positron emission topography-computed tomography maximum intensive projection showed a thickened medial rectum wall with homogeneous uptake of 18F-fluorodeoxy-glucose, and the maximum standardized uptake value was 14.6.

Figure 4 Histopathological and immunohistochemical staining of rectal cancer. A: Postoperative pathology revealed ulcerative, moderately to poorly differentiated adenocarcinoma; B: Negative staining for Epstein-Barr virus-encoded ribonucleic acid.

Figure 5 Next-generation sequencing test in rectal cancer specimens. A: Tumor protein 53 (TP53; NM_000546.5) nonsense mutation in exon 9 c.991C>T (p.Gln331*), AF 3.71%; B: TP53 (NM_000546.5) missense mutation in exon 8 c.844C>T (p.Arg282Trp), AF 37.89%.

Figure 6 Mutation of waveform of the tumor protein 53 gene fragment. A and B: There were no base mutations.

Figure 7 The timeline of diagnosis and treatment for multiple primary malignant neoplasms. EBER: Epstein-Barr virus-encoded ribonucleic acid; TP53: Tumor protein 53.