Synchronous cholangiocarcinoma and cervical squamous cell carcinoma managed via a multidisciplinary approach: A case report.

Abstract

Background: Multiple primary cancers refer to the presence of two or more distinct malignant tumors in a single individual, either simultaneously or sequentially. The synchronous occurrence of cholangiocarcinoma (CCA) and cervical squamous cell carcinoma (SCC) is extremely rare. This case highlights the diagnostic challenges and significance of a multidisciplinary team in managing complex malignancies involving both the hepatobiliary and gynecologic systems. The 8^th edition of the American Joint Committee on Cancer staging system was as follows: T1aN0M0 intrahepatic CCA; the 2018 edition of the International Federation of Gynecology and Obstetrics staging system was stage IB1 cervical SCC.

Case summary: A 74-year-old postmenopausal woman (Karnofsky performance status = 80) presented with a one-day history of vaginal bleeding. Cross-sectional imaging (contrast-enhanced computed tomography, liver magnetic resonance imaging, and positron emission tomography/computed tomography) first demonstrated a single 3-cm lesion in liver segment V and a hypermetabolic cervical mass. Subsequent ultrasound-guided liver biopsy confirmed CCA, whereas cervical biopsy revealed SCC. After multidisciplinary discussion, the patient underwent laparoscopic liver resection. Pelvic external-beam radiotherapy was delivered at 45 grays in 25 fractions (6-megavolt photons) over 5 weeks, followed by high-dose-rate ¹⁹²Ir intracavitary brachytherapy, at 35 grays in 7 fractions (International Commission on Radiation Units and Measurements A-point). She received eight cycles of systemic therapy with lenvatinib, capecitabine, and camrelizumab. Over a 12-month follow-up, she remained disease-free with no signs of recurrence or metastasis.

Conclusion: Multidisciplinary management offers a promising strategy for treating synchronous complex malignancies with individualized treatment plans.