Hematological Malignancies With Multiple Primary Cancers: A Rare Case Presentation.

BACKGROUND

Two or more primary cancers that arise in two different patients are referred to as multiple primary cancers. We record those cases because optimal therapy requires interdisciplinary cooperation.

CASE 1: A 53-year-old male presented with intermittent hematuria for one year, fever, burning micturition, appetite loss, and a 3 kg weight loss over 2 months. His CBC showed 81% atypical cells, and bone marrow aspiration and flow cytometry indicated Precursor B-ALL. He started on the BFM-2002-protocol but had persistent hematuria. The USG of the whole abdomen revealed a urinary bladder mass. TURBT and histopathology confirmed low-grade, noninvasive papillary urothelial neoplasm. Thus, he was diagnosed with Precursor B-ALL and Low-Grade Papillary Urothelial Neoplasm Noninvasive.

CASE 2: A 53-year-old male with a history of anaplastic oligodendroglioma (diagnosed in 2022) presented to the emergency with altered sensorium, headache, and convulsions. He had received radiotherapy and chemotherapy for the past year. In December 2023, he experienced convulsions again due to a recurrence of the oligodendroglioma. His CBC showed an increasing total leukocyte count, reaching 100,000 over five months. Bone marrow and molecular studies indicated a myeloproliferative neoplasm, specifically chronic myeloid neoplasm (CMN) in the chronic phase, with BCR-ABL1 p210 positive. He was diagnosed with recurrent anaplastic oligodendroglioma (WHO Grade 3) and CMN in the chronic phase.

CONCLUSION

An increased prevalence of second primary malignancy is anticipated due to the rising cancer burden and the careful screening of index initial malignancy throughout therapy. Determining the best course of action requires careful staging of the cancer and discussion by a multidisciplinary team.