P1377 - A Case Report of Synchronous Dual Primary Malignancies: Diffuse Large B Cell Lymphoma and Hepatocellular Carcinoma

Joseph Choi, DO¹, Akil Olliverrie, MD², Nikisha Pandya, MD¹, Michael Bernstein, MD^1
1South Brooklyn Health, Brooklyn, NY; ²NYC Health + Hospitals/South Brooklyn Health, Brooklyn, NY

Introduction: Multiple primary malignancies (MPM) is defined as two or more histopathologically distinct malignancies in the same individual. It is classified into two main categories; Synchronous which describes tumors diagnosed within 6 months of each other, or Metachronous which describes tumors diagnosed beyond 6 months apart.

Case Description/Methods: Our case presents a 74-year-old female with a past medical history of osteoarthritis of the right shoulder who presented to the emergency department due to right shoulder pain. Initial evaluation revealed pancytopenia with an elevated alkaline phosphatase. Imaging revealed a pathological proximal humeral meta-diaphysis fracture with underlying lytic lesions with biopsy of the lesions positive for large B-cell lymphoma (Image A.).

Given the elevated ALK, and negative autoimmune/infectious serological screen, a triple phase CT was performed which revealed an ill-defined, heterogeneously enhancing mass in the right hepatic lobe suggestive of HCC (Image B.). A diagnosis of Synchronous Multiple Primary Malignancies was made, and each malignancy was treated independently, after a multidisciplinary approach (IR, GI and Oncology), TACE for HCC and R-CHOP for B-Cell Lymphoma.

Discussion: Our case is unique since most of the reported cases share a common theme; concomitant chronic hepatitis and the presence of both disease entities on perihepatic lymph node or liver histology, which our case lacks. The importance of reporting is to encourage advancement in treatment options since the practical implications of the management of patients with multiple primary malignancies are rarely discussed. When in a patient two active malignancies are diagnosed, the challenge is to find an anticancer therapy strategy that covers both cancer types without increased toxicity or relevant pharmacological interactions.



Disclosures:


Joseph Choi, DO¹, Akil Olliverrie, MD², Nikisha Pandya, MD¹, Michael Bernstein, MD¹. P1377 - A Case Report of Synchronous Dual Primary Malignancies: Diffuse Large B Cell Lymphoma and Hepatocellular Carcinoma, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.