CRA57 SYNCHRONOUS TUMORS – WHAT’S THE CULPRIT?

Alia Anis Yahya, Majidah Razak, Azlina Samsuddin

Hospital Sultanah Nurzahirah, Terengganu, Malaysia

INTRODUCTION
Synchronous tumor is defined as simultaneous occurance or within 6 months from each other.

The prevalence rate is estimated to be 4.5 % to 11.7 % with mostly higher than 75 % of diagnosed patients belong to the >50 years old population group.

CASE SUMMARY:
A 57 year old gentleman had multiple hospitalisations for ESBL Klebsiella pneumonia for the past 2 months. He was presented with persistent hemoptysis, nocturnal fever followed by weightloss and inappetance. He was diagnosed with Hepatocellular carcinoma with underlying chronic Hepatitis B 4 months prior to the episode and under treatment (TACE). Clinically, he is cachectic, mild tachypneoic and jaundiced. His laboratory results shown leucocytosis with sputum c&s shown Klebsiella pneumonia.  CT Thorax shown lung nodule over the right middle lobe, left lower lobe and right lower lobe with primary HCC tumor segment V-VII. Initial diagnosis was HCC with lung metastases. Bronchoscopy was done due to persistent hemoptysis showing multiple small nodules over the left lingular segment, and biopsy taken shown adenocarcinoma. AFP and Glypican 3 are negative. Then the diagnosis was revised as concurrant HCC and lung adenocarcinoma.

DISCUSSION
Differentiation between metastasis and synchronous tumor is essential as it determines the prognosis and treatment. Clinical,,molecular (genetic) and immunohistochemistry able to determine the origin of cancer. The occurance of EHPMs were lung cancer (15%), followed by colorectal tumors and stomach cancer. Different mechanisms have played a crucial role in pathogenesis -including hereditary, immune and environmental exposures such as significant cigarette smoking history, viruses, chemicals, chemotherapeutics, ionizing radiation and aging.

CONCLUSION
A prompt diagnosis and staging of synchronous primary tumours are essential for appropriate treatment.