Multiple primary neoplasms developing in a case of prostate cancer.

Carcinoma ofprostate is the second most common cause of cancer death in men in the UK. It is known that patients with carcinoma of prostate are at significant risk of developing a second primary neoplasm.' These second primary are mainly colorectal, stomach or urinary bladder. The histopathology of gastrointestinal tumours is usually adenocarcinoma. We report a case of prostate cancer that developed an unusual combination of atrial myxoma, small bowel carcinoid, basal cell cancer on shoulder skin, rectosigmoid adenocarcinoma and caecal adenoma over a period of five years. CASE REPORT A 73 years old man presented with significant bladder outlet obstruction in 1996. On clinical examination he had a smooth enlarged prostate. The postate specific antigen (PSA) was elevated at 38.5ng/1. Transurethral resection of prostate was performed; 21gm of this was resected. The histopathology report was adenocarcinoma of prostate (Gleason score 3, in 90% of resected tissue). The staging CT scan was normal, and bone scan revealed a suspicious area of increased uptake near the right femoral metaphysis. The patient was started on hormonal treatment in the form of Goserelin injections. The serum PSA level returned to normal within 1 year and has remained within the normal range for 5 years. A bone scan repeated after 3 years was also normal. In March 2001 the patient presented with vomiting and abdominal distension. X-ray showed features consistent with small bowel obstruction. An exploratory laprotomy was carried out. A small bowel tumour was identified with extensive mesenteric lymphadenopathy and was resected. Histopathology confirmed small bowel carcinoid. All the mesenteric lymph nodes were negative for metastases. In July 2001 the patient presented with bleeding per rectum. Colonoscopy showed a rectosigmoid pedunculated polyp more than 2 centimetres and moderate divericular disease ofthe sigmoid colon. The rectosigmoid polyp was snared and excised and was confirmed to be an adenoma with a focus of adenocarcinoma. In 2001 a 1cm lesion on the left shoulder was biopsied and found to be a basal cell cancer. It was treated with flurouracil cream and colistin sulphate and polymyxin B sulphate cream. On routine follow-up colonoscopy in November 2001, a flat growth in the rectum was found along with a large polypoid lesion in the caccum and a small polyp in the transverse colon. The histopathology confirmed the presence of a rectal adenocarcinoma and a tubulovillous adenoma of the caecurn with no dysplasia.