Multiple Primary Cancers In The Head And Neck:A Case Report And Literature Review

Objective: To explore the etiology,diagnosis,treatment and prognosis of multiple primary cancers(MPC)and MPC in the head and neck regions for improving the diagnosis and treatment and lowering the rate of missed diagnosis and misdiagnosis.Methods: This article,to report one case report of patients with MPC in the head and neck regions,in which we reviewed related literatures,through to its clinical manifestation,laboratory examination,imaging examination and histopathology results,diagnosis,relevant treatment and prognosis,has a systematic analysis and research.Case presentation: A 72-year-old male patient is in hospital on May 18,2015 because of a mass on his left neck three years ago and hoarseness two months ago.Three years ago,the patient inadvertently found that there was a mass on his left neck with thumb size,but he never paid attention to it.Then the mass enlarged gradually.He suffered hoarseness which coughed and produced mucous sputum occasionally within the last two months,but no chills,fever,hemorrhage,dyspnea,dysphagia or cough during eating.The patient was admitted to other hospital on Apr,2015 due to these symptoms,diagnosed with laryngeal cancer.Then he had surgery,but gave no exact details.Postoperative pathology showed laryngeal carcinoma.Otolaryngologist check: there was 5 cm long scar on the anterior neck and a 3.0cm × 3.0cm enlarged node on the left side of his neck found in levels I and II.The node was firm,fixed and painless with unclear edge.The laryngoscope revealed a rough tumor at the left ventricular bands and epiglottic tubercle.After admission the patient was laryngoscope-guided biopsy.Throat histopathological examination showed laryngeal neuroendocrine carcinoma.Then we completed a operation on the patient include total laryngectomy and a selective left neck dissection(levels Ⅰ、Ⅱ、Ⅲ、 Ⅳ).The postoperative pathological diagnosis:(1)Combined with immunohistochemistry,histopathology of the exogenous mass which is about 3 cm away from the free edge of epiglottis showed LNEC,involving epithelium,acinus and left cervical lymph nodes;(2)It showed the basaloid squamous carcinoma of larynx combined with immunohistochemistry;(3)There are ten lymph nodes on the left neck.One of them confirmed that the patient was with lymph node metastasis of papillary carcinoma thyroid combined with cell shape and immunohistochemistry.The postoperative course was uneventful but the patient refused to have thyroid biopsy.Given that the patient is recovering from operation at an old age,there won’t be another operation in a short time.He was discharged with the metallic tracheal cannula on Jun 18,2015.The patient died in one month through telephone follow-up survey.Conclusions: MPC is related to heredity,environment and personal lifestyle,iatrogenic factors,virus infection,age,sex,race and so on.But the etiology and its mechanism remain controversial.It still needs basic research and verification.Its diagnosis depends on pathological examination,especially by immunohistochemical examination.Prognosis is dependent on the most aggressive tumor,regardless of the number.A correct and complete preoperative evaluation is important for the choice of operative method and its range.It can improve survival.