Introduction: The incidence of multiple primary carcinomas (MPCs) is increasing but remains a rare diagnosis. MPCs are two or more unrelated cancers in one patient. The development of MPCs is theorized to be related to unhealthy lifestyles and genetic susceptibility. We present a previously healthy male without family history of GI malignancy diagnosed with synchronous gastroesophageal junction (GEJ) and gastric adenocarcinoma.
Case Description/Methods: A 41-year-old male without prior medical history presented with recent onset solid food dysphagia associated with worsening abdominal pain, weight loss, and dyspnea for 5 months. He denied alcohol or tobacco use, or family history of malignancy. Labs showed normal CEA and CA 19-9, and Computed Tomography (CT) of the chest and abdomen revealed bilateral pleural effusion with left lung collapse, numerous pulmonary nodules and enlarged mediastinal and abdominal lymph nodes (Figure A-B). There was a circumferential esophageal thickening at the GEJ and a concern for interstitial edematous pancreatitis (Figure C-D). Magnetic Resonance Imaging (MRI) of the abdomen revealed mesenteric nodularity concerning for peritoneal carcinomatosis and diffuse gastric wall and GEJ thickening concerning for malignancy (Figure E). His QuantiFERON-TB Gold (QFT) was positive, but AFB smears and PCR test were negative, consistent with latent TB. Upper GI endoscopy revealed extensive nodularity of the esophageal and gastric mucosa with a large ulcerated GEJ mass (Figure F-J). Gastric and esophageal biopsies revealed invasive adenocarcinoma with a differential expression of p53 staining, extensive mucinous features but without signet ring cells. Pleural and peritoneal fluid cytology were consistent with metastatic adenocarcinoma of primary GI origin. His hospital course was complicated by recurrent pleural effusions, pulmonary embolism and upper gastrointestinal bleeding. Patient was followed with oncology for chemoradiation therapy for advanced unresectable gastric and GEJ adenocarcinoma with distant metastasis.
Discussion: Esophageal and gastric cancer risks are modulated by multiple factors, including genetic susceptibility modifying environmental factors. Synchronous GEJ and gastric adenocarcinoma are rare and often confused with recurrence or metastasis of malignant tumors. Inactivation of the TP53 gene plays a crucial role in the formation of solid GI tumors
