Synchronous Tumours: A Combination of Carcinoid and Adenocarcinoma

Abstract

Synchronous tumour refers to cases in which the second primary cancer is diagnosed within six months of primary cancer. Carcinoid tumours are innocuous at time of presentation, emphasising the need for multidisciplinary approach for the diagnosis. A 80-year-old male patient came with complaints of cough with expectoration on and off for three years, with occasional minimal haemoptysis, haematemesis on and off for two months, loss of weight and loss of appetite for the past two months and complaints of increased cough for the past 1 week. Chest X-ray showed ill-defined opacity in the left lower zone. Contrast enhanced computed tomography showed two well defined heterogenous enhancing lesion in the superior and lateral basal segment of left lower lobe. Bronchoscopy guided biopsy revealed typical carcinoid. In view of recurrent diarrhoea, patient underwent endoscopy which revealed poorly differentiated adenocarcinoma. Gastrointestinal symptoms along with lung symptoms can be attributed to disseminated carcinoid or carcinoid syndrome. Carcinoid syndrome occurs in fewer than 5% of cases. It presents with symptoms like diarrhoea, wheezing, palpitations, hypotension. In the present case authors were attributing the gastric symptoms to carcinoid syndrome. Endoscopy was done in view of diarrhoea which revealed a second malignancy. Multiple tumours diagnosed have to be evaluated and staged separately and the treatment should be decided on staging to attain maximum clinical response. Patient condition worsened and patient expired in two weeks. All symptoms in a tumour patient should not be attributed to paraneoplastic syndromes and metastasis, further workup should be done using a multidisciplinary approach.