SHM Converge Scientific Abstract ePoster Gallery-Triple Trouble - A Concomitant Presentation of Three Primary Malignancies

Pdf Summary

A 61-year-old man presented with headache, epistaxis, dysphagia, weight loss, chronic cough, and a history of smoking and long-term benzene/chemical exposure. Imaging revealed a large invasive nasopharyngeal mass encasing the carotids, cervical lymphadenopathy, a cavitary right upper lobe lung lesion with hilar/paratracheal nodes, scattered lytic bone lesions, and a T12 pathologic fracture causing severe spinal canal stenosis with cord compression and edema.<br /><br />Biopsies showed three separate malignancies: the nasopharyngeal mass was Epstein-Barr virus–negative poorly differentiated squamous cell carcinoma, the paratracheal lymph node was poorly differentiated adenocarcinoma, and the spinal lesion was plasma cell neoplasm. Bone marrow biopsy showed no excess clonal plasma cells, supporting a localized plasma cell tumor rather than multiple myeloma. PET-CT demonstrated marked FDG avidity in the nasopharyngeal and lung lesions and lymph nodes, but not in the osseous lesions.<br /><br />He was initially spine-symptom-free despite the severe spinal findings, prompting multidisciplinary consultation with interventional radiology, neurosurgery, and radiation oncology. Because plasma cell tumors are radiosensitive, he received palliative radiation followed by surgical stabilization. The case emphasizes the importance of thorough social and exposure history, especially when evaluating possible exposure-related cancers, and highlights the need for early multidisciplinary management in neoplastic spinal cord compression.<br /><br />Despite treatment, the disease progressed, and the patient eventually transitioned to hospice care and died four months later. This case illustrates an unusual Hickam’s dictum presentation of three concurrent primary malignancies.

Asset Subtitle

Ziheng Xu

Meta Tag

Author List Alvin George, Jesse Yoon, Nathan Martin, Ziheng Xu

Category Clinical Vignettes

Concept Primary Cancer

Concept Malignant Spinal Cord Compression

Concept Biopsy

Concept Nasopharyngeal Squamous Cell Carcinoma

Concept Lung Adenocarcinoma

Distinguished Non-Finalist

Presenter Organization Washington University School of Medicine

Presenting Author Ziheng Xu

Track Adult

Keywords

nasopharyngeal carcinoma

epistaxis

dysphagia

smoking history

benzene exposure

lung adenocarcinoma

plasma cell neoplasm

spinal cord compression

multidisciplinary management

multiple primary malignancies

Primary Cancer

Malignant Spinal Cord Compression

Biopsy

Nasopharyngeal Squamous Cell Carcinoma

Lung Adenocarcinoma