Triple Synchronous Tumors Presenting as Right Nasolabial Basal Cell Carcinoma, Papillary Thyroid Carcinoma and Prolactinoma: A Rare Case Report

Mateo  Te III; Donnah Bless Lumanlan-Mosqueda; Kenny Jun  Demegillo

doi:10.15605/jafes.035.02.08

Authors

Mateo Te III Southern Philippines Medical Center, Davao City https://orcid.org/0000-0002-0411-8597
Donnah Bless Lumanlan-Mosqueda Southern Philippines Medical Center, Davao City
Kenny Jun Demegillo Southern Philippines Medical Center, Davao City

DOI:

https://doi.org/10.15605/jafes.035.02.08

Keywords:

multiple primary, synchronous tumors

Abstract

Multiple primary tumors are rare, with a published meta-analysis that shows the frequency of second primary tumor at 3-5%, and a third tumor at 0.5%. A 57-year-old female sought consultation due to a persistently bleeding right nasolabial mass. On further history and examination, she also presented with a right anterior neck mass, repeated abortions, secondary amenorrhea, and loss of libido years prior. Serum prolactin was significantly elevated and an incidental finding of a pituitary mass on head and neck CT scan was appreciated. Metastasis and syndromic familial disorder were ruled out. Bromocriptine was given and she underwent total thyroidectomy and wide excision of the right nasolabial mass which turned out to be papillary thyroid carcinoma (PTC) and basal cell carcinoma (BCC) respectively on histopathologic report. On follow up, repeat serum prolactin decreased to normal levels. After extensive literature review, this is the first documented case of triple synchronous tumors with a combination of BCC of the right nasolabial area, PTC and prolactinoma in local, national and international studies. With comprehensive work up and literature search, the diagnosis was established and ultimately the patient benefited from a multidisciplinary management.

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Author Biographies

Mateo Te III, Southern Philippines Medical Center, Davao City

Senior Resident

Donnah Bless Lumanlan-Mosqueda, Southern Philippines Medical Center, Davao City

Professor, Department of Endocrinology

Kenny Jun Demegillo, Southern Philippines Medical Center, Davao City

Professor, Department of Oncology

References

Bittorf B, Kessler H, Merkel S, et al. Multiple primary malignancies: An epidemiological and pedigree analysis of 57 patients with at least three tumors. Eur J Surg Oncol. 2001;27(3):302-13. https://www.ncbi.nlm.nih.gov/pubmed/11373110. https://doi.org/10.1053/ejso.2001.1112.

National Cancer Institute. SEER Program Code Manual, 3rd ed. Bethesda (MD): National Cancer Institute, 1998. https://seer.cancer.gov/archive/manuals/codeman.pdf.

North American Association of Central Cancer Registries. Howe HL, ed. A review of the definition for multiple primary cancers in the United States: Workshop proceedings from December 4-6, 2002 in Princeton, New Jersey. https://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.466.3479&rep=rep1&type=pdf.

Ferlay J, Soerjomataram I, Dikshit R, et al. Cancer incidence and mortality worldwide: Sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer. 2015;136(5):E359-86. https://www.ncbi.nlm.nih.gov/pubmed/25220842. https://doi.org/10.1002/ijc.29210.

Laudico AV, Mirasol-Lumague MR, Medina V, Mapua CA, Valenzuela FG, Pukkala E. 2015 Philippine cancer facts and estimates. Philippine Cancer Society: Manila, 2015. http://www.philcancer.org.ph/wp-content/uploads/2017/07/2015-PCS-Ca-Facts-Estimates_CAN090516.pdf.

Apalla Z, Lallas A, Sotiriou E, Lazaridou E, Ioannides D. Epidemiological trends in skin cancer. Dermatol Pract Concept. 2017;7(2):1-6. https://www.ncbi.nlm.nih.gov/pubmed/ 28515985. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5424654. https://doi.org/10.5826/dpc.0702a01.

Leiter U, Eigentler T, Garbe C. Epidemiology of skin cancer. Adv Exp Med Biol. 2014;810:120-140. https://www.ncbi.nlm.nih.gov/pubmed/25207363. https://doi.org/10.1007/978-1-4939-0437-2_7.

Saquian FYN. Basal cell carcinoma of the lip and mentum. Philipp J Otolaryngol Head Neck Surg. 2006;21(1,2):54-6.

Schlumberger MJ, Filetti S, Hay ID. Nontoxic diffuse and nodular goiter and thyroid neoplasia. In: Williams Textbook of Endocrinology, 12 ed., chapter 14, 2011. https://doi.org/10.1016/B978-1-4377-0324-5.00014-6.

Gloria JDLS, Pontejos Jr AQY, Grullo PER. Risk factors for recurrent papillary thyroid carcinoma. Philipp J Otolaryngol Head Neck Surg. 2017;32(2):25-9. https://journal.pso-hns.org/wp-content/uploads/2017/11/orig-article-Risk-FactorS-2.pdf.

Arafah BM, Nasrallah MP. Pituitary tumors: Pathophysiology, clinical manifestations and management. Endocr Relat Cancer. 2001;8(4):287-305. https://www.ncbi.nlm.nih.gov/pubmed/11733226. https://doi.org/10.1677/erc.0.0080287.

Mindermann T, Wilson CB. Age-related and gender-related occurrence of pituitary adenomas. Clin Endocrinol (Oxf). 1994;41(3):359-64. PMID: 7893282. https://doi.org/10.1111/j.1365-2265.1994.tb02557.x.

Ciccarelli A, Daly AF, Beckers A. The epidemiology of prolactinomas. Pituitary. 2005;8(1):3-6. https://www.ncbi.nlm.nih.gov/pubmed/16411062. https://doi.org/10.1007/s11102-005-5079-0.

Carucci JA, Leffell DJ, Pettersen JS. Basal cell carcinoma. In: Fitzpatrick’s Dermatology in General Medicine. Volume 1, chapter 115, 2012.

Portela RA, Choby GW, Manni A, Campbell D, Crist H, Goldenberg D. Unusual sites of metastasis of papillary thyroid cancer: Case series and review of the literature. Ear Nose Throat J. 2015;94(8):E43-7. https://www.ncbi.nlm.nih.gov/pubmed/26322457.

Melmed S, Jameson L .Pituitary tumor syndromes. In: Harrison’s Principles of Internal Medicine. 20th ed, volume 2, chapter 373.

Cardino MJT, Lantion-Ang FL. Insulinoma and prolactinoma in a young female: A variant of multiple endocrine neoplasia 1 (MEN-1). Philipp J Intern Med. 2009;47:137-42. https://www.pcp.org.ph/documents/PJIM/Volume%2047%20(2009)/Number%203%20(May-June)/7-Insulinoma%20and%20Prolactinoma.pdf.

Brandi ML, Gagel RF, Bilezikian JP, et al. Guidelines for diagnosis and therapy of MEN type 1 and type 2. J Clin Endocrinol Metab. 2006;86(12):5658-71. https://www.ncbi.nlm.nih.gov/pubmed/11739416. https://doi.org/10.1210/jcem.86.12.8070.

Majumdar A, Mangal NS. Hyperprolactinemia. J Human Reprod Sci. 2013;6(3):168-75. https://www.ncbi.nlm.nih.gov/pubmed/24347930. PMCID: PMC3853872. https://doi.org/10.4103/0974-1208.121400.

Kleinberg DL, Noel GL, Frantz AG. Galactorrhea: A study of 235 cases including 48 with pituitary tumors. N Engl J Med. 1977;296(11):589-600. https://www.ncbi.nlm.nih.gov/pubmed/840242. https://doi.org/10.1056/NEJM197703172961103.

Tolis G, Somma M, Campenhout JV, Friesen H. Prolactin secretion in sixty-five patients with galactorrhea. Am J Obstet Gynecol. 1974;118(1):91-101. https://www.ncbi.nlm.nih.gov/pubmed/4202979. https://doi.org/10.1016/s0002-9378(16)33651-1.

Boyd 3rd AE, Reichlin S, Turksoy RN . Galactorrhea-amenorrhea syndrome: Diagnosis and therapy. Ann Intern Med. 1977;87(2);165-75. https://www.ncbi.nlm.nih.gov/pubmed/407824. https://doi.org/10.7326/0003-4819-87-2-165.

Kawaguchi T, Ogawa Y, Tominaga T. Diagnostic pitfalls of hyperprolactinemia: The importance of sequential pituitary imaging. BMC Res Notes. 2014;7:555. https://www.ncbi.nlm.nih.gov/pubmed/25142896. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4148930. https://doi.org/10.1186/1756-0500-7-555.

Shucart WA. Implications of very high serum prolactin levels associated with pituitary tumors. J Neurosurg. 1980;52(2):226-8. https://www.ncbi.nlm.nih.gov/pubmed/7351562. https://doi.org/10.3171/jns.1980.52.2.0226.

Lugo G, Pena L, Cordido F. Clinical manifestations and diagnosis of acromegaly. Int J Endocrinol. 2012;2012:540398. https://www.ncbi.nlm.nih.gov/pubmed/22518126. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3296170. https://doi.org/10.1155/2012/540398.

Bornstein SR, Allolio B, Arlt W, et al. Diagnosis and treatment of primary adrenal insufficiency: An Endocrine Society Clinical Practice Guideline. 2016;101(2):364-89. https://www.ncbi.nlm.nih.gov/pubmed/26760044. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4880116. https://doi.org/10.1210/jc.2015-1710.

Schlechte J.. Approach to the patient: Long term management of prolactinomas. J Clin Endocrinol Metab. 2017;92(8):2861-5. https://doi.org/10.1210/jc.2007-0836.

Wei ZH, Gong W, Zhou M, Chen QM. The concept of field cancerization and its clinical application. Zhonghua Kou Qiang Yi Xue Za Zhi. 2016;51(9):562-5. https://www.ncbi.nlm.nih.gov/pubmed/27596348. https://doi.org/10.3760/cma.j.issn.1002-0098.2016.09.011.

Mohan M, Jagannathan N. Oral field cancerization: An update on current concepts. Oncol Rev. 2014; 8(1): 244. https://www.ncbi.nlm.nih.gov/pubmed/25992232. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4419611. https://doi.org/10.4081/oncol.2014.244.

Yatavelli RKR, Bhusal K. Prolactinoma. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan. 2020 Aug 10. https://www.ncbi.nlm.nih.gov/pubmed/29083585. NBK459347.

Indrasena BSH. Use of thyroglobulin as a tumour marker. World J Biol Chem. 2007;8(1): 81-5. https://www.ncbi.nlm.nih.gov/pubmed/28289520. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5329716. https://doi.org/10.4331/wjbc.v8.i1.81.

Lyons DJ, Hellysaz A, Broberger C. Prolactin regulates tuberoinfundibular dopamine neuron discharge pattern: Novel feedback control mechanisms in the lactotrophic axis. J Neurosci. 2012; 32(23):8074-83. https://www.ncbi.nlm.nih.gov/pubmed/22674282. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6620951. https://doi.org/10.1523/JNEUROSCI.0129-12.2012.

Shah M, Agarwal R, Gupta S, et al. Triple primary malignancies in head-and-neck region: A report of four cases. South Asian J Cancer. 2017;6(4):194-5. https://www.ncbi.nlm.nih.gov/pubmed/29404306. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5763638. https://doi.org10.4103/sajc.sajc_225_17.

Singh NJ, Tripathy N, Roy P, Manikantan K, Arun P. Simultaneous triple primary head and neck malignancies: A rare case report. Head and Neck Pathol. 2016;10(2):233-6. https://www.ncbi.nlm.nih.gov/pubmed/26477035. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4838955. https://doi.org/10.1007/s12105-015-0664-7.

Yalavarthi S, Pamu PK, Thoondla M, Gupta S. Metachronous malignancies in head and neck region: Report of two cases. Indian J Pathol Microbiol. 2014;57(2):314-6. https://www.ncbi.nlm.nih.gov/pubmed/24943776. https://doi.org/10.4103/0377-4929.134728.

Umeshappa H, Chandrashekhar M, Shenoy AM, Dinesh Kumar GR. Triple simultaneous primary tumors of the head and neck: A rare case report. Int J Case Rep Images 2014;5(7):488-91. https://doi.org/10.5348/ijcri-201485-CR-10396.

Nishikawa K, Kawada J, Fujitani K, et al. A case of metachronous triple cancer with multimodal approach including surgical resection. Gan To Kagaku Ryoho. 2014;41(12):2033-5. https://www.ncbi.nlm.nih.gov/pubmed/25731413.

Clarke DR, Smallman LA, Rhys-Evans PH. Triple primary malignant neoplasms in the head and neck. J R Soc Med. 1986;79(11): 676-7. https://www.ncbi.nlm.nih.gov/pubmed/3795214. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1290538.