Chromium is a heavy metal that shows superior corrosion resistance, rigidity and luster, and has been used in various industries as a plating material, oxidizer, catalyzer and pigment. Long-term exposure to hexavalent chromium (Cr (VI)) can cause dermatitis, skin ulcers, conjunctivitis, keratitis, nasal mucositis, and/or nasal septal perforation. In addition, exposure to Cr (VI) has also been reported to increase the risk for lung cancer among workers in the chromate-producing industry. Cr (VI) has been designated as a carcinogen for lung cancer by the International Agency for Research on Cancer. Cr (VI) has also been shown to be capable of inducing stomach and colon cancers, and less often, nasal and paranasal sinus malignancies.
Herein, we report a rare case of synchronous double cancer of the lung and nasopharynx arising in a chrome-plating worker. A 60-year-old man who had been working in the chrome-plating industry for 32 years was referred to our institute with a 5-month history of neck swellings and a nodular shadow on chest X-ray. Physical, rhinoscopic and endoscopic examinations showed enlarged walnut-sized cervical lymph nodes on both sides, a large nasal septal perforation, and an ulcerative tumor in the posterosuperior nasopharyngeal wall. Computed tomography and magnetic resonance imaging revealed multiple lymph nodes measuring 30 mm in maximum diameter on both sides of the neck, a weakly enhancing protuberance in the nasopharynx, and a 30-mm nodule with spicula and vascular convergence in the lower lobe of the left lung. Endoscopic biopsies were performed, and the nasopharyngeal and lung lesions were diagnosed histopathologically as nonkeratinizing carcinoma and squamous cell carcinoma, respectively. Thoracoscopic left lower lobectomy with hilar and mediastinal dissection was performed for the lung tumor, and the nasopharyngeal cancer was treated subsequently by induction chemotherapy followed by concurrent chemoradiotherapy. The posttreatment course was uneventful, and the patient has remained free of recurrence during the 6-month follow-up period since.
