Multiple primary malignancies (MPMs) are more than one synchronous (within 6-month interval) or metachronous (more than 6-month interval) cancers diagnosed in a patient in the same or different organ system. We present a challenging case of a 72-year-old male who presented with sinus congestion refractory to medical treatment and was found to have a hard palate swelling. The biopsy revealed diffuse large B cell lymphoma (DLBCL). Subsequent staging positron emission/computed tomography (PET/CT) scans showed another hypermetabolic mass in the anterior mediastinum, the pathology of which confirmed the presence of synchronous small cell lung cancer (SCLC). The patient received a combination of chemotherapy and radiation for both masses. Interval PET/CT scans done six months from the initial diagnoses showed an improvement in both masses, but also revealed an initially missed 2 cm solid right renal mass suggestive of synchronous renal cell carcinoma (RCC), which was confirmed by biopsy and treated with cryoablation. Targeted genomic profiling tests subsequently revealed six germline variants (ERCC4 P472L, FGFR4 T179M, FGFR4 G388R, FLT3 A953V, MSH2 Q397E and RAD52 S407G) as well as a variety of somatic variants in different tissue samples. This case highlights the diagnostic and therapeutic challenges in managing patients with MPMs and the potential complex clinical significance of germline and somatic variants.

Medical implants play a key role in treating bone fractures. Permanent implants are currently used for immobilization of fractures and bearing physiological loads during bone healing. After bone has healed, these implants, if not removed, often cause complications in the long run; and secondary surgeries for removing them pose additional discomfort and expenses for patients. Magnesium (Mg)-based bioresorbable implants, can potentially eliminate the need for additional surgeries by degrading safely over time in the human body. When studying the degradation behaviors of Mg-based implants in vitro, it is important to simulate physiological conditions in vivo closely, including loading. Considering that implants often carry physiological loads in vivo and mechanical stresses affect the degradation rate of Mg, a novel loading device was designed and manufactured for studying Mg degradation under load over a long period of time in a simulated body fluid in vitro. Degradation of Mg rods were investigated by immersing in a revised simulated body fluid (rSBF) for two weeks while a consistent compressive load was applied using the loading device. The results showed that the loading device provided a consistent load of 500 ± 45 N during the two weeks of immersion. Mg rods showed a significant faster degradation rate under the applied load, as demonstrated by a higher mass loss of the sample, a higher pH increase and Mg²⁺ ion release in the rSBF.