From the Guidelines
To write a comprehensive case report on multiple primary malignant neoplasms (MPMN), I strongly recommend structuring it with key sections that highlight the complexity of managing concurrent or sequential primary malignancies. For your case report, I suggest including the following sections:
- Introduction (briefly explaining MPMN and its significance)
- Patient Information (demographics, risk factors)
- Clinical Findings (symptoms, physical examination)
- Timeline (sequence of cancer diagnoses)
- Diagnostic Assessment (imaging, pathology results for each primary cancer)
- Therapeutic Intervention (treatment approaches for each cancer, including specific chemotherapy regimens, radiation doses, surgical procedures)
- Follow-up and Outcomes (response to treatment, complications, survival)
- Discussion (highlighting unique aspects of your case, challenges in management, and clinical implications) 1. For the narration, focus on the chronological development of each primary cancer, emphasizing diagnostic challenges, treatment decisions, and how managing multiple cancers affected the overall approach, as suggested by recent studies on metachronous and synchronous primary lung cancers 1. Include specific details about tumor characteristics (histology, stage, molecular markers), exact treatment protocols used (drug names, dosages, cycles completed), and outcomes measured, considering the latest recommendations from the international association for the study of lung cancer pathology committee 1. The case report should prioritize the clinical implications of MPMN management, particularly regarding treatment prioritization, potential drug interactions, cumulative toxicity considerations, and surveillance strategies, to provide practical insights for clinicians facing similar cases. When discussing treatment approaches, consider the standard approach for treatment in patients with either synchronous or metachronous MPLC, which includes surgery as a primary treatment option, and adjuvant chemotherapy or targeted therapy based on the tumor's molecular profile 1. The decision regarding adjuvant therapy should be made on a case-by-case basis, taking into account the biology of each tumor and the potential for distinct responses to specific therapies 1. By following this structure and emphasizing the clinical implications of MPMN management, you can create a comprehensive and clinically valuable case report that highlights the unique challenges of managing concurrent or sequential primary malignancies.
From the Research
Case Report Outline
To write a case report about multi primary malignant neoplasm, consider the following outline:
- Introduction to the case: brief overview of the patient's condition and the purpose of the report
- Patient's history: relevant medical history, including previous cancers and treatments
- Presentation of the case: description of the current condition, including symptoms, diagnosis, and treatment
- Discussion: analysis of the case, including any unique features, challenges, and outcomes
- Conclusion is not necessary as per the guidelines, instead, focus on the key points and takeaways from the case
Key Elements to Include
When writing the case report, be sure to include the following elements:
- Clear and concise language
- Relevant medical history and previous treatments
- Description of the current condition, including symptoms, diagnosis, and treatment
- Analysis of the case, including any unique features, challenges, and outcomes
- Relevant imaging or diagnostic tests
- Treatment outcomes and any complications
Structure and Style
The structure of a case report usually comprises a short unstructured (or no) abstract, brief (or no) introduction, succinct but comprehensive report of the case, and to-the-point discussion 2. Case reports should be short and focused, with a limited number of figures and references.
Examples of Multi Primary Malignant Neoplasms
There have been several reported cases of multi primary malignant neoplasms, including:
- A 79-year-old woman with quadruple primary tumors, including a bone tumor, a malignant bladder tumor, a malignant melanoma, and an intrahepatic cholangiocarcinoma 3
- A female patient with primary synchronous tumors of the breast and pectoral skin 4
- A 57-year-old man with non-small cell lung cancer, gastrointestinal stromal tumors, and lumbar vertebral malignant mucinous sarcoma 5
- A patient with a history of rectal cancer, bladder cancer, and hepatocellular carcinoma 6
Management and Treatment
The management of multi primary malignant neoplasms can be challenging, and there is no standard protocol for clinical management 3. A multidisciplinary physician team is necessary to ensure favorable outcomes 4. The decision regarding which tumor to treat initially, and how to schedule further treatments according to individual tumor risk, is crucial 4. Next-generation sequencing (NGS) testing is necessary for clinical management, and systemic treatment based on concurrent multiple main tumors is the key to improving prognosis 3.