OncoTargets and therapy · 2026
Synchronous Early Gastric Adenocarcinoma and Cervical Carcinoma of Unknown Primary with Metachronous Hepatocellular Carcinoma: A Case Report.
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Li Yupeng, Zhao Hongyan, Fu Chunqing, Gong Lei, Li Dongming, Lin Xianke, Ran Bo
Аннотация
INTRODUCTION: Diagnosing multiple primary malignancies requires integration of chronology, histology, immunophenotype, imaging findings, and clinical course, and must be distinguished from recurrence or metastatic disease.
CASE PRESENTATION: A 69 year-old male patient presented in October 2022 with a painless right cervical mass. Biopsy showed tumor cells arranged in nests with necrosis, enlarged hyperchromatic nuclei, and frequent mitoses. Immunohistochemistry showed CK positivity, focal CK5/6 and CK7 positivity, a Ki-67 index greater than 90%, focal TTF-1 positivity, and negativity for CD56, CgA, Syn, P40, Napsin A, and EBER, supporting poorly differentiated carcinoma of unknown primary rather than conventional squamous cell carcinoma. During the same diagnostic period, endoscopic submucosal dissection of a gastric angle lesion revealed moderately to poorly differentiated adenocarcinoma, type 0-IIc, measuring 3×1 cm, with deep submucosal invasion (SM3), no lymphovascular or perineural invasion, a negative lateral margin, and a very close vertical margin. The pathological stage was pT1bNxMx. The patient received cervical radiotherapy and systemic treatment mainly consisting of nedaplatin plus toripalimab, with marked regression of the cervical lesion. In 2026, a hepatic segment 6 nodule was detected and biopsy confirmed hepatocellular carcinoma. The patient was negative for hepatitis B and C virus infection, but had a 30-year alcohol history and a smoking history. None of his four siblings had a history of malignancy.
CONCLUSION: The cervical poorly differentiated carcinoma of unknown primary, gastric adenocarcinoma, and hepatocellular carcinoma showed distinct histological and immunophenotypic features. Their chronology and clinical course support multiple primary malignancies rather than metastatic recurrence from a single primary tumor.
CASE PRESENTATION: A 69 year-old male patient presented in October 2022 with a painless right cervical mass. Biopsy showed tumor cells arranged in nests with necrosis, enlarged hyperchromatic nuclei, and frequent mitoses. Immunohistochemistry showed CK positivity, focal CK5/6 and CK7 positivity, a Ki-67 index greater than 90%, focal TTF-1 positivity, and negativity for CD56, CgA, Syn, P40, Napsin A, and EBER, supporting poorly differentiated carcinoma of unknown primary rather than conventional squamous cell carcinoma. During the same diagnostic period, endoscopic submucosal dissection of a gastric angle lesion revealed moderately to poorly differentiated adenocarcinoma, type 0-IIc, measuring 3×1 cm, with deep submucosal invasion (SM3), no lymphovascular or perineural invasion, a negative lateral margin, and a very close vertical margin. The pathological stage was pT1bNxMx. The patient received cervical radiotherapy and systemic treatment mainly consisting of nedaplatin plus toripalimab, with marked regression of the cervical lesion. In 2026, a hepatic segment 6 nodule was detected and biopsy confirmed hepatocellular carcinoma. The patient was negative for hepatitis B and C virus infection, but had a 30-year alcohol history and a smoking history. None of his four siblings had a history of malignancy.
CONCLUSION: The cervical poorly differentiated carcinoma of unknown primary, gastric adenocarcinoma, and hepatocellular carcinoma showed distinct histological and immunophenotypic features. Their chronology and clinical course support multiple primary malignancies rather than metastatic recurrence from a single primary tumor.