A case of two synchronous independent primary cancers: Esophageal squamous cell carcinoma and vulvar squamous cell carcinoma (Not HPV-related)

Background: Esophageal cancer and vulvar cancer are both uncommon malignancies in the USA. Cases are related to HPV and smoking in both malignancies. Case Report: We report the first case of two synchronous independent primary esophageal and vulvar cancers unrelated to HPV in a 55 years old female who presented with a fall and head trauma. Upon trauma assessment, imaging showed a mid- esophageal thickening as well as a vulvar mass and a left inguinal lymphadenopathy. Biopsies showed squamous cell adenocarcinoma in both the esophageal and vulvar masses. Based on the mode of spread and the rarity of vulvar metastasis from esophageal cancer, we postulated that they are two locally advanced different malignancies. Conclusion: This case highlights the diagnostic dilemma of differentiating a metastatic lesion versus another primary and imposes a challenge in therapeutic strategies. The prompt management plan is essential and should be separate for the two malignancies, starting with esophageal malignancy, which is the most lethal of the two. We would like to emphasize on the rare occurrence of a second malignancy and to differentiate that situation from a metastasis is not well defined. This situation requires us to use more clinical judgment based on epidemiology and mode of spread of each malignancy.