Шаблоны LeoTheme для Joomla.
GavickPro Joomla шаблоны

Case report

A Rare Tumoral Combination, Renal Cell Carcinoma, Breast Carcinoma and Non- Hodgkin Lymphoma and Review of the Literature

Şebnem İzmir Güner1, Didem Karacetin2*, Ekrem Güner3 M.Teoman Yanmaz4, Mahmut Yüksel5

1Medicalpark Bahçelıevler Prıvate Hospıtal, Department of Hematology Istanbul,Turkey
2Istanbul Research and Training Hospıtal, Department of Radıatıon Oncology Istanbul, Turkey
3Bakırköy Doctor ,Sadı Konuk Research and Traınıng Hospıtal, Department of Urology Istanbul, Turkey
4Medicalpark Bahçelievler, Prıvate Hospıtal, Department of Medical Oncology Istanbul,Turkey
5Medicalpark Bahçelievler, Prıvate Hospıtal, Department of Nuclear Medicine Istanbul,Turkey

*Corresponding author: Didem Karacetin, Istanbul Research and Training Hospıtal, Department of Radıatıon Oncology Istanbul, Turkey, Email: didemkaracetin@gmail.com

Submitted: 12-21-2015 Accepted: 02-04-2016 Published: 02-28-2016

Download PDF





Multiple consecutive cancers involving different organs in a female individual are presented. Here in, we present a rare case of primary left renal cell carcinoma (RCC), in which two different malignancies of left cervical lymph node and left breast were occurred consecutively. We present the case of a 84-year-old female with three primary malignant neoplasms detected synchronously. She was admitted to our clinic with left neck upper mass.The result of the left cervical lymph node biopsy revealed diffuse B large cell lymphoma, the result of the left breast biopsy revealed well differantiated invasive ductal carcinoma and the result of the kidney’s noduler biopsy was clear cell carcinoma respectively. Rituximab chemotherapy was started as the lymphoma treatment because of the patients age and low performance status. Pathological assessment of newly detected lesions in multiple primary cancer cases is important for the treatment approach.

Keywords: Renal Cell Carcinoma; Breast Carcinoma; Non- Hodgkin Lymphoma


Multiple primary cancers are defined as occurrence of two or more malignancies, synchronous or metachronous, in different organs without any relation to each other [1].

Cancer survivors are a growing group owing to improvements in scanning and treatment. In this group the most serious event is the diagnosis of a new second cancer. Also older people population increases. Because of these two reasons multiple primary cancers are likely to increase. Cancer patients have a 20% higher risk of new primary cancer, in the same organ or in another organ, compared with the general population. Also, second cancers have become a leading cause of death among long-term cancer survivors [1,2].

The first report of multiple primary malignant neoplasms in an individual patient was published at the end of the 19th century. Since then, several papers worldwide have addressed this issue and the prevalence of multiple primary malignant neoplasms reported varies from 0.734% to 11.7% [3-5]. The etiopathogenesis of multiple neoplasms includes hereditary aspects, the influence of environmental agents,previous therapies and tumor-producing hormones [5-8].

Multiple neoplasms could be defined when they occur as synchronous or metachronous. The development of second cancer in cancer survivor is expected but third, or higher order malignancies are rare. The letter is applied for the neoplasms appearing in a single patient [5,9].

Herein, we report a case of a patient diagnosed with cervical nodal DLBCL in a private hospital where staging workup also  revealed synchronous left breast carcinoma and left renal cell carcinoma . A review of the relevant literature is also discussed.

Case Report

A 84-year-old female was admitted to our clinic with left neck upper masse. On physical examination, left neck upper masse about 2-3 cm was found and Eastern Cooperative Oncology Group=ECOG” was 2. Fever, night sweats or weight loss was not noted.

A neck ultrasound demonstrated left middle posterior cervical, bilateral submandibular-cervical lymph nodes. She underwent excisional biopsy of the left cervical node which demonstrated DLBCL (Figure 1). Her bone marrow biopsy was negative for malignancy. Due to the findings on her staging PET/CT scan and a palpable mass in the left breast, a bilateral mammogram was performed that showed a solid density in the vicinity of the left breast mass. Ultrasound-guided needle core biopsy of the breast lesions demonstrated well differantiated invasive ductal carcinoma in the left breast (Figure 2), also in the PET/CT scan there were bilateral axiller,aortopulmoner, prevascular,bilateral hiler,subcarinal,hepatic hilus, paraaortic,left iliac series ,right external iliac and bilateral inguinal lymph nodes and left renal anterolateral 4.5x4.7 cm large nodullary mass (Figure 4). Kidney’s biopsy was clear cell carcinoma (Figure 3).

Figure 1. Left neck node biopsy demonstrating diffuse large Bcell lymphoma.

cancer fig 30.1

Figure 2. Left breast infiltrating ductal carcinoma.

cancer fig 30.2

Figure 3. Left renal clear cell carsinoma.

cancer fig 30.3

Figure 4. PET/CT scan images before treatment

cancer fig 30.4

Figure 5. PET/CT scan images after treatment.

cancer fig 30.5

cancer table 30.1

She was treated with Rituximab 375 mg/m2 D1 + Metilprednizolone 40 mg/m2 D1-5 every 21 day. After 4 cycles response was evaluated as partial response and very good partial response after 8 cycles of chemotherapy. Her clinical status, 6 months after the diagnosis was good.


As the use of PET/CT scans for the staging of malignancies has become more common, the detection of second occult malignancies has also increased. A recent prospective study of non-Hodgkin lymphoma patients staged by PET/CT demonstrated that 2.9% of them had a second, occult, nonlymphoma malignancy [11,12]. Although there are wellestablished guidelines for the workup, staging, and treatment of individual malignancies, optimal treatment in the setting of multiple simultaneous malignancies is difficult.

The literature contains several small case series and individual case reports of patients with primary breast malignancies with synchronous lymphoproliferative disorders including follicular lymphoma [11,13-15], small lymphocytic lymphoma/chronic lymphocytic leukemia [11,14,16]. Hodgkin  lymphoma [10], mantle cell lymphoma [11,15], MALT lymphoma [17,18]. Two individual case reports document primary breast carcinoma with simultaneous DLBCL; these both occurred in the breast rather than in the axilla [19,20].

The increased risk of subsequent malignancies among cancer survivors is well-established and initially diagnosed with cancer ages 30 to 49. Second primary cancers can be examined into three categories; therapy releated, syndromic and those resulting from shared etiologic influences by Travis et al [21]. Warren and Gates established three criteria:

1. each of the tumors must have a definite features of malignancy,
2. each must be distinct, and
3. the probability of one being a metastasis of the other must be excluded [22].
By this definition, our patient had three different primary malignant neoplasms.

Watanabe et al. analyzed multiple primary malignancies in 285 (5.2%) double primary cancers, 58 (1.1%) triple or more in 5,456 consecutive autopsy cases [23]. In Antal et al.’s study with 719 cancer patients, multiple malignancies were found in 53 cases (7.4%). 49 of these being second malignancy and 4 were third malignancy.

Colorectal and gynecological malignancies appeared with breast cancer in 5 cases [24] Ng et al. Reported 181 patients second malignancies in 1,319 Hodgkin lymphoma patients.


In conclusion, the appropriate use of sensitive staging studies makes the discovery of occult simultaneous malignancies a distinct possibilityal also we need an improvement for our knowledge of the risks and patterns of high-order malignancies. Careful review of these studies with evaluation and discussion in a multidisciplinary setting ensures the most efficacious treatment regimen is planned and executed to maximize the chance of cure of these malignancies.



1. Soerjomataram I, Coebergh JW. Epidemiology of multiple primary cancers. Methods Mol Biol. 2009, 471: 85-105.

2. Demirci U, Coşkun U, Göçün P U. Four different malignancies in one patient: a case report. Cases Journal. 2010, 3: 53.

3. Berge T, Cederqvist L, Schonebeck J. Multiple primary malignant tumours. An autopsy study of a circumscribed population. Acta Pathol Microbiol Scand. 1969,76: 171-183.

4. AJ Haddow, J F Boyd. Multiple primary neoplasms in the Western Hospital Region, Scotland: A survey based on cancer registration data. Scottish medical journal. 1972, 17: 143-152.

5.Özbudak I H, Özbudak Ö, Arslan G. Metachronous Malignant Mesothelioma and Pulmonary Adenocarcinoma. Turkish Journal of Pathology. 2013, 29: 83-86.

6. Sozzi G, Miozzo M, Pastorino U. Genetic evidence for an independent origin of multiple preneoplastic and neoplastic lung lesions. Cancer Res. 1995, 55: 135-140.

7. Leone G, Mele L, Pulsoni A. The incidence of secondary leukemias. Haematologica. 1999, 84: 937-945.

8.Habal N, Sims C, Bilchik AJ. Gastrointestinal carcinoid tumors and second primary malignancies. J Surg Oncol. 2000, 75: 310-316.

9.Matzkin H, Braf Z. Multiple primary malignant neoplasms in the genitourinary tract: Occurrence and etiology. J Urol. 1989, 142(1): 1-12.

10. Warren S, Gates O. Multiple primary malignant tumors: A survey of the literature and a statistical study. Am J Cancer. 1932, 16: 1358-1114.

11. T Papajik, M Myslivecek, Z Ssedova. Synchronous second primary neoplasms detected by initial staging F-18 FDG PET/CT examination in patients with non-Hodgkin lymphoma. Clinical Nuclear Medicine.2011, 36(7): 509-512.

12. Miles E F, Jacimore LL. Synchronous Bilateral Breast Carcinoma and Axillary Non-Hodgkin Lymphoma: A Case Report and Review of the Literature. Case Reports in Oncological Medicine. 2012, 2012: 685919.

13. M D Laudenschlager, K L Tyler, M C Geis. A rare case of synchronous invasive ductal carcinoma of the breast and follicular lymphoma. South Dakota Medicine. 2010, 63(4):123–125.

14. K E Cuff, A J Dettrick, B. Chern. Synchronous breast cancer and lymphoma: a case series and a review of the literature. Journal of Clinical Pathology. 2010, 63(6): 555-557.

15. J Cox, L Lunt, L Webb. Synchronous presentation of breast carcinoma and lymphoma in the axillary nodes. Breast. 2006, 15(2): 246-252.

16. D Wahner-Roedler, C Reynolds, J. Boughey. Collision tumors with synchronous presentation of breast carcinoma and lymphoproliferative disorders in the axillary nodes of patients with newly diagnosed breast cancer: a case series. Clinical Breast Cancer. 2001, 11(1): 61-66.

17. B Susnik, J J Rowe, P N Redlich. A unique collision tumor in breast: invasive ductal carcinoma and mucosa-associated lymphoid tissue lymphoma. Archives of Pathology and Laboratory Medicine. 2004, 128(1): 99-101.

18. J M Quilon, T A Gaskin, A S Ludwig. Collision tumor: invasive ductal carcinoma in association with mucosa-associated lymphoid tissue (MALT) lymphoma in the same breast. Southern Medical Journal. 2006, 99(2): 164–167.

19. F. A. Siddiqui, V.Maheshwari, K. Alam. Coexistent non- Hodgkins lymphoma and ductal carcinoma breast: diagnosis on fine needle aspiration cytology. Diagnostic Cytopathology. 2011, 39(10): 767–769.

20. S Broco, N Bonito, P Jacinto. Primary non-Hodgkin lymphoma and invasive ductal carcinoma in the same breast: a rare case report. Clinical and Translational Oncology. 2011, 11(3): 186-188.

21. Travis LB, Hill D, Dores GM. Cumulative absolute breast cancer risk for young women treated for Hodgkin lymphoma. J Natl Cancer Inst. 2005, 97: 1428-1437.

22.Warren S, Gates O. Multiple primary malignant tumors: A survey of the literature and a statistical study. Am J Cancer. 1932, 16: 1358-1114.

23. Watanabe S, Kodama T, Shimosato Y. Multiple primary cancers in 5,456 autopsy cases in the National Cancer Center of Japan. J Natl Cancer Inst. 1984, 72: 1021-1027.

24. Antal A, Vallent K. Cases of multiple tumors in our clinic. Orv Hetil. 1997,138:1507-1510.

Cite this article: Karacetin. A Rare Tumoral Combination, Renal Cell Carcinoma, Breast Carcinoma and Non- Hodgkin Lymphoma and Review of the Literature. J J Cancer Sci Res. 2016, 2(2): 030.

Contact Us:
TRAIL # 150 W
E-mail : info@jacobspublishers.com
Phone : 512-400-0398