Endocrine Abstracts

Introduction: Multiple primary cancers are a rare entity; however their incidence is increasing due to advances in diagnostic methods and surveillance strategies. The coexistence in the same patient of several primary malignant tumors has been described in the literature with a frequency varying from 5.5% to 8.5%.

The aim of this observation is to report a case associating 3 neoplasias:medullary thyroid carcinoma (MTC), papillary thyroid carcinoma (PTC) and a renal carcinoma.

Case report: A 49-year-old male patient consulted for a compressive thyroid goiter. A Fine-needle aspiration biopsywas conducted, revealing a MTC. A laryngectomy with total thyroidectomy, bilateral mediastino-recurrent lymph node dissectionwith the installation of a tracheostomy was performed. The pathology study showed 2 synchronous thyroid tumors: medullary and papillary thyroid carcinoma. MTC invaded the trachea with lymph node metastases, classified as pT4a N1b, as for PTC, it was 1.8 cm in length with lymph node metastases, classifiedas pT2 N1b. The extension assessment identified costal bone metastases and a left renal tumor, which turned out to be a renal tubulo-papillary carcinoma at histological examination. For the PTC, the patient was treated with 200 mCi of iodine-131 with negativation of thyroglobulins. However, the MTC evolution was not the same; the basal serum level of calcitonin has increased, with the progression of bone metastases. As for the family history, there was no record of any thyroid or kidney tumors. The final treatment of the patient was mainly palliative.

Conclusion: The coexistence of several neoplasias is rare, and poses major diagnostic and therapeutic problems, and it requires multidisciplinary management. The role of genetic study is essential in this area to codify these different diseases into a syndromic approach.