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E-JCRT CORRESPONDENCE
Year : 2015  |  Volume : 11  |  Issue : 4  |  Page : 1039

The utility of [18F] fluorodeoxyglucose-positron emission tomography/computed tomography for detecting lung and esophagus multiple primary cancers involved in the larynx: Two case reports


Department of Otolaryngology, The First Affiliated Hospital, College of Medicine, Zhe Jiang University, Zhe Jiang, Hangzhou, PR China

Date of Web Publication15-Feb-2016

Correspondence Address:
Qinying Wang
Department of Otolaryngology, The First Affiliated Hospital, College of Medicine, Zhe Jiang University, Zhe Jiang, Hang Zhou 310003
PR China
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0973-1482.147384

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 > Abstract 

Multiple primary cancers involved in the larynx of differentiating synchronous multiple primary cancers from metastasis can often be very difficult, especially when they have the same histology. However, it is very important because the therapeutic approach is completely different. Clinical situations like this appear to be increasing as a result of the recent popular use of [18F] fluorodeoxyglucose-positron emission tomography/computed tomography. Herein, we report two cases of multiple primary cancers involved in the larynx.

Keywords: Larynx, multiple primary cancer, positron emission tomography/computed tomography


How to cite this article:
Wang Q, Chai L, Zhou S. The utility of [18F] fluorodeoxyglucose-positron emission tomography/computed tomography for detecting lung and esophagus multiple primary cancers involved in the larynx: Two case reports. J Can Res Ther 2015;11:1039

How to cite this URL:
Wang Q, Chai L, Zhou S. The utility of [18F] fluorodeoxyglucose-positron emission tomography/computed tomography for detecting lung and esophagus multiple primary cancers involved in the larynx: Two case reports. J Can Res Ther [serial online] 2015 [cited 2019 Sep 21];11:1039. Available from: http://www.cancerjournal.net/text.asp?2015/11/4/1039/147384


 > Introduction Top


Laryngeal carcinoma has been widely reported in the literature to be the most common primary tumor of all the malignant tumors of the head and neck region. It is also the tumor, usually, associated with the onset of a second primary tumor. The second primary neoplasm that may arise in these patients is more frequently localized in the lung or the upper respiratory and digestive tracts (URDT), but differentiating synchronous multiple primary cancers from metastasis can often be very difficult, especially when they have the same histology. However, it is very important because the therapeutic approach is completely different. Clinical situations like this appear to be increasing as a result of the recent popular use of [18F] fluorodeoxyglucose (FDG)-positron emission tomography (PET)/computed tomography (CT). [1],[2],[3],[4],[5] Herein, we report two cases of multiple primary cancers involved in the larynx and discuss the pertinent problem on this subject.


 > Case reports Top


Case 1

A 68-year-old man was first seen in the Department of Otolaryngology on January 21, 2009 complaining of intermittent hoarseness and cough. Laryngoscopy revealed neoplasm of the right vocal cord [Figure 1]. A tumor in the right lower lobe of the lung was demonstrated by chest CT. The patient continued to smoke about two packages of cigarettes daily for 40 years. 18FDG-PET/CT imaging was performed for initial staging [Figure 2], which showed along with a focal hypermetabolic lesion of lung cancer in the right lung [Figure 3], another foci with increased metabolic activity was found in the right vocal cords [Figure 4].
Figure 1: Laryngoscopy revealed neoplasm of the right vocal chord

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Figure 2: 18[F]fluorodeoxyglucose-positron emission tomography/computed tomography imaging showed a focal hypermetabolic lesion in the right lung and the right vocal cords

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Figure 3: 18[F]fluorodeoxyglucose-positron emission tomography/computed tomography imaging showed along with a focal hypermetabolic lesion of lung cancer in the right lung

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Figure 4: 18[F]fluorodeoxyglucose-positron emission tomography/computed tomography imaging showed increased metabolic activity was found in the right vocal cords

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Bronchoscopy demonstrates squamous cell carcinoma arising from the superior segment bronchus of the right lower lobe, and malignant cells were found in the sputum and bronchial secretions. Right cordectomy and right pneumonectomy were performed. Histologic examination of both the resected vocal cord and lung revealed squamous cell carcinoma. He was well and active, and exhibited no evidence of recurrence for >3 years after treatment.

Case 2

A 54-year-old man was seen in the Department of Otolaryngology on May 15, 2010 complaining of hoarseness of 5 months' duration. He had smoked one package of cigarettes daily for 35 years. A mass was seen on the left vocal cord by laryngoscopy [Figure 5]. He was previously healthy and did not present any symptoms. Neck CT showed nodules in the left neck, subclavicular lymph nodes, and left armpit lymph node with enlargement of the mediastinal lymph nodes. Percutaneous needle aspiration biopsy of the nodule showed tumor cells. 18FDG-PET/CT was performed for the staging workup of cancer. A focal hypermetabolic lesion of laryngeal cancer in the left cord, others foci with increased metabolic activity were found in the lower thoracic esophagus, nodules in the left neck, subclavicular lymph nodes, left armpit lymph node, and mediastinal lymph nodes [Figure 6]. The pathologic examination of the procured tissue specimens confirmed that both of them were squamous cell carcinoma [Figure 7]. Subsequently, 4 cycles of chemotherapy with paclitaxel (175 mg/m 2 on day 1) and carboplatin (area under the curve of 6 on day 1) were given. The size and extent of the esophageal and laryngeal cancers were also reduced by chemotherapy. Thereafter, the patient underwent radiation therapy with a dose of 65 Gy to both lesions, which may be led to complete resolution. At the time of this report, the patient has died.
Figure 5: Laryngoscopy revealed neoplasm of the left vocal chord

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Figure 6: 18[F]fluorodeoxyglucose-positron emission tomography/ computed tomography imaging showed increased metabolic activity in the left cord, lower thoracic esophagus, nodules in the left neck, subclavicular lymph nodes, left armpit lymph node, and mediastinal lymph nodes

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Figure 7: Histological assessment of the esophagus tumor shown squamous cell carcinoma by gastrofiberscope biopsy (H and E, ×50)

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 > Discussion Top


Laryngeal carcinoma, usually, associated with the onset of a second primary tumor. Hence, laryngeal carcinoma has the role of an "index tumor" in the neoplastic pathology of the head and neck. [6] The second primary neoplasm that may arise in these patients is more frequently localized in the lung or the URDT, whereas it is less often encountered in other organs, as these tumors have a multifactorial pathogenesis and the mucosal tissues of a same region are subjected to the same predisposing factors (tobacco, alcohol, asbestos, sulfuric acid, and ionizing radiation) and may, therefore, develop concomitant or successive lesions. In our report, one localized in the lung, another localized in the digestive tracts, and they had smoking history.

The observation of multiple primary malignant neoplasms was considered quite exceptional in the previous century. [7] Two classifications are currently in use. The first describes multiple primary tumors as multicentric, systemic, or coincidental on the basis of tumor site. The second classification, which was proposed by Moertel, [8] is based on the time interval between the onset of the tumors, which are defined as simultaneous, synchronous, or metachronous. When the two tumors are diagnosed concomitantly, they are considered "simultaneous." If the diagnosis of the second tumor is made within 6 months from the first, they are said to be "synchronous;" if the time interval is longer than 6 months, they are defined as "metachronous." In our report, the two tumors were diagnosed concomitantly, they were considered "simultaneous."

Synchronous double primary tumors are not uncommon. However, there are only rare studies that have reported primary tumors that developed simultaneously in a patient, as in our case. Currently, FDG-PET/CT is widely used for the evaluation of malignant disease. It has helped detect hidden metastatic cancer or other synchronous primary cancers with increasing frequency. [9] Ishimori et al. showed that FDG-PET/CT detected hidden primary malignant tumors in ≥1.2% of the patients with cancer. [10] Taken together with our cases, 18FDG-PET/CT seems necessary to evaluate patients with cancer, especially when there is a reasonable chance for cure.

The number of patients with multiple cancers is expected to increase as a result of prolonged patient survival and improved diagnostic techniques. It is important to differentiate multiple primary cancers from metastasis because of the different therapeutic approaches; 18FDG-PET/CT was useful to rule out the presence of a hidden malignancy.


 > Acknowledgment Top


The authors express their gratitude to Zhao Kui, MD, at Department of PET Center, The First Affiliated Hospital, College of Medicine, Zhe Jiang University, for his professional critiques and images.

 
 > References Top

1.
Kaida H, Ishibashi M, Kurata S, Uchiyama Y, Tanaka N, Abe T, et al. The utility of FDG-PET for detecting multiple primary cancers in hypopharyngeal cancer patients. Nuklearmedizin 2009;48:179-84.  Back to cited text no. 1
    
2.
Desai B, Elatre W, Quinn DI, Jadvar H. FDG PET/CT demonstration of pancreatic metastasis from prostate cancer. Clin Nucl Med 2011;36:961-2.  Back to cited text no. 2
    
3.
Wu YC, Hsieh TC, Kao CH, Yen KY, Sun SS. Simultaneous rectal schwannoma and prostatic adenocarcinoma detected on FDG PET/CT. Clin Nucl Med 2011;36:948-9.  Back to cited text no. 3
    
4.
Calvo FA, Domper M, Matute R, Martínez-Lázaro R, Arranz JA, Desco M, et al. 18F-FDG positron emission tomography staging and restaging in rectal cancer treated with preoperative chemoradiation. Int J Radiat Oncol Biol Phys 2004;58:528-35.  Back to cited text no. 4
    
5.
Tanabe S, Naomoto Y, Shirakawa Y, Fujiwara Y, Sakurama K, Noma K, et al. F-18 FDG PET/CT contributes to more accurate detection of lymph nodal metastasis from actively proliferating esophageal squamous cell carcinoma. Clin Nucl Med 2011;36:854-9.  Back to cited text no. 5
    
6.
Perego V. Association between primary cancer of the larynx and primary cancer of the lung. Acta Otorhinolaryngol Ital 1985;5 Suppl 8:3-16.  Back to cited text no. 6
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7.
Lundgren J, Olofsson J. Multiple primary malignancies in patients treated for laryngeal carcinoma. J Otolaryngol 1986;15:145-50.  Back to cited text no. 7
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8.
Moertel CG. Incidence and significance of multiple primary malignant neoplasms. Ann N Y Acad Sci 1964;114:886-95.  Back to cited text no. 8
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9.
Agress H Jr, Cooper BZ. Detection of clinically unexpected malignant and premalignant tumors with whole-body FDG PET: Histopathologic comparison. Radiology 2004;230:417-22.  Back to cited text no. 9
    
10.
Ishimori T, Patel PV, Wahl RL. Detection of unexpected additional primary malignancies with PET/CT. J Nucl Med 2005;46:752-7.  Back to cited text no. 10
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7]



 

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