Double Synchronous Primary Tumors: Metastatic Melanoma and Advanced Pulmonary Adenocarcinoma in a 32-Year-Old Adult: Case Report and Literature Review
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Abstract
Introduction: The presence of multiple primary malignant neoplasms is an unusual finding during the diagnostic approach of patients with cancer. The coexistence of melanoma with lung adenocarcinoma is extremely rare according to some cohort studies since a prevalence of 0.05% is estimated in this group of patients. The most relevant risk factors for the development of multiple malignant tumors are genetic, environmental exposures to carcinogenic substances, and treatment of a preexistent cancer.
Case description: Male, 32 years old who denies family history of malignant neoplasms, drug addiction, chronic degenerative diseases, allergies, surgeries, and hospitalizations. His main symptom was a progressive weakness of the right upper and lower limb which, over a period of days, made it impossible to walk. During his hospitalization, MRI revealed metastatic lesions associated with vasogenic edema. For this reason, an evaluation was requested by the neurosurgery service, who performed a decompressive craniectomy with a biopsy that reported malignant cells consistent with metastatic melanoma. As part of the diagnostic approach, a thoracoabdominal CT with IV contrast was performed, which revealed another tumor at the lung level in the left lower lobe that obliterates the bronchus, not suggestive of metastatic activity, for this reason a lung biopsy was performed, which reported findings of poorly differentiated adenocarcinoma with angiolymphatic invasion present and extensive necrosis. The patient was discharged home with the palliative care measures due to the poor prognosis of both stage IV cancers reported synchronously. Conclusion: The coexistence of 2 primary different cancers in the same patient is an unusual phenomenon which represents a challenge for the multidisciplinary team that treats the patient. Likewise, the coexistence between melanoma and lung adenocarcinoma is exceptionally reported in the literature, which in advanced phases confers a poor prognosis and few therapeutic options.
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