Vol 44 # 4 December 2012 - Kma.org.kw

December 2012
KUWAIT MEDICAL JOURNAL 346
Table 1: The differences between collision tumor and other similar phenomena
Phenomenon Example Explanation
Collision tumor
Collision metastasis
Composite tumor
Hybrid tumor
Multiphasic tumor
Endometrial carcinoma and adjacent endocervical
carcinoma
Axillary lymph node showing breast and ovarian
carcinomas
A lymph node containing classic Hodgkin’s lymphoma and
T-cell lymphoma
Concomitant basal cell adenoma and canalicular adenoma
of the parotid
Wilm’s tumor
Two tumors with different cell origin arise
proximal to each other
The two tumors meet outside their primary
organs
Two different tumors fuse and intermingle
between each other
Two tumor entities share a similar cellular origin
A single tumor entity with different morphologic
patterns
impact on the diagnosis and modality of treatment,
dozens of cases of collision tumors have been reported.
Besides, an attempt to discover a relationship between
the originating tumors is usually made.
Our case does not fall under any definition, as
it includes one primary and one metastatic tumor.
However, as there is no strict definition for this situation
in the literature, we prefer to consider it as collision
tumor, and to restrict “collision metastasis” to cases
when both tumors collide outside their primaries [4] .
Prostatic carcinoma occurring together with CLL was
reported in the literature [5-8] , but with different clinical
scenarios. None of the previously reported cases showed
a collision metastasis between prostatic carcinoma and
CLL. We are unaware of a similar reported case where
collision metastasis was the first hint for the presence of
two hidden neoplasms.
It was demonstrated that patients with CLL are
susceptible to develop other primary malignancies. In
the large study carried out by Hisada et al, 2% of patients
with CLL developed prostate carcinoma, with a relative
risk of 1.01 [9] . The study did not specify the relationship
between the two neoplasms or the common risk factors
between them. However, the relative increased incidence
of both neoplasms in older ages, with the relative
indolent course of CLL, may suggest this occurrence.
The immune derangement status, believed to occur in
CLL [7,9] would predispose to a second malignancy, though
this relation is not well proved in prostatic carcinoma. A
recent finding showed that deletion at 13q14 occurs in
60% of prostatic carcinoma and more than 50% of CLL,
suggesting a shared pathway at the molecular level [10] .
Our patient received hormonal therapy for prostate
carcinoma. He was unfit for chemotherapy for CLL.
Unfortunately, the patient had tumor progression and
died seven months later from extensive metastasis.
CONCLUSION
We conclude that a collision tumor of both CLL and
prostate carcinoma exists, although rare. Physicians
should be aware of the possible second malignancy in
patients with CLL, and should not stop at peripheral
blood smear findings alone.
ACKNOWLEDGMENT
Conflict of interest: none
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