• Liang-Ke Tang, Zhi-Ke Li, Ya-Lang Xiang, Dai-Yuan Ma, and Guo-Bo Du.
• Department of Oncology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China.
• Medicine (Baltimore). 2023 Jul 28; 102 (30): e34349e34349.

RationaleMultiple primary malignant tumors are rare and challenging to diagnose. Diffuse malignant peritoneal mesothelioma (DMPM) originate from the peritoneum, which lacks specific clinical manifestations and is difficult to diagnose, with a short survival about 10 to 13 months for inoperable ones. This is the first report of metachronous double primary malignant tumors in nasopharyngeal carcinoma and DMPM accompanied with paraneoplastic syndromes.Patient ConcernsA 61-year-old man presented with abdominal discomfort with a history of nasopharyngeal carcinoma 5 years ago.DiagnosesThe diagnosis of DMPM was finally confirmed by laparoscopic mesenteric biopsies. Paraneoplastic syndromes including increased platelets were present when diagnosis, followed by increased neutrophils after disease progression.InterventionsDue to intolerable for surgery, he was treated with pemetrexed combined with nivolumab, intraperitoneal infusion of nivolumab, radiotherapy, anlotinib and maintenance treatment of nivolumab.OutcomesProgression-free survival in first line is 12 months, overall survival is 23 months.LessonsThis indicate that comprehensive treatment including immunotherapy may be helpful for inoperable DMPM patients with nasopharyngeal carcinoma accompanied with paraneoplastic syndromes.Copyright © 2023 the Author(s). Published by Wolters Kluwer Health, Inc.

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