J Gynecol Oncol.  2008 Dec;19(4):265-269. 10.3802/jgo.2008.19.4.265.

A case report of quadruple cancer in a single patient including the breast, rectum, ovary, and endometrium

• Noh SK
• Yoon JY
• Ryoo UN
• Choi CH
• Sung CO
• Kim TJ
• Bae DS
• Kim BG

• KMID: 2173418
• DOI: http://doi.org/10.3802/jgo.2008.19.4.265

Abstract

Multiple primary cancer is defined as the multiple occurrence of malignant neoplasms in the same individual. Due to the development of new diagnostic techniques and the rise in long-term survival of cancer, reports of multiple primary cancers have gradually increased. Herein, we describe the case of a 68-year-old female patient with quadruple primary cancer of the breast, rectum, ovary, and endometrium. For its great rarity, we report this case with a review of the literature.

Keyword

Multiple primary cancer; Quadruple cancer

MeSH Terms

Aged
Breast
Breast Neoplasms
Endometrium
Female
Humans
Ovary
Rectum

Figure

• 

  Fig. 1 Endoscopic mucosal resection of the rectal polyp showing a moderate to poorly differentiated adenocarcinoma with submucosal invasion (hematoxylin and eosin ×40).

• 

  Fig. 2 (A) Pelvis ultrasonography of a 7.8×6.0 cm-sized, multiseptated, solid portion-containing mass arising from the right ovary. (B) Pelvis ultrasonography of hydrometra of 3.6 mm thickness. (C) Abdominopelvic CT showing a 6 cm-sized cyst.

• 

  Fig. 3 Serous adenocarcinoma of the right ovary displaying complex papillary structures covered by secondary micropapillae with exfoliation of tumor cells (hematoxylin and eosin, ×40).

• 

  Fig. 4 Serous adenocarcinoma arising from the endometrium, mostly confined within the endometrium (A), and background serous intraepithelial carcinoma (B) with strong anti-p53 antibody immunoreactivity (B, inset) (hematoxylin and eosin ×40 [A], ×200 [B], and immunohistochemistry ×100 [B inset]).

Reference

1. Nakayama H, Masuda H, Ugajin W, Nakamura Y, Akiyama K, Suzuki K, et al. Quadruple cancer including bilateral breasts, Vater's papilla, and urinary bladder: Report of a case. Surg Today. 1999. 29:276–279.

2. Ayhan A, Yalçn OT, Tuncer ZS, Gügan T, Küçüali T. Synchronous primary malignancies of the female genital tract. Eur J Obstet Gynecol Reprod Biol. 1992. 45:63–66.

3. Moertel CG, Dockerty MB, Baggenstoss AH. Multiple primary malignant neoplasm: II. Tumors of different tissues or organs. Cancer. 1961. 14:231–237.

4. Billroth T. General surgical pathology and therapeutics in 51 Vorlesungen: A textbook for students and physicians in fifty-one lectures. 1889. 14th ed. Berlin, DE: G. Rerimer.

5. Warren S, Gates O. Multiple primary malignant tumors; Surgery of literature and statistical study. Am J Cancer. 1932. 16:1358–1414.

6. Moertel CG. Multiple primary malignant neoplasms: Historical perspectives. Cancer. 1977. 40:Suppl 4. 1786–1792.

7. Slaughter DP, Southwick HW, Smejkal W. Field cancerization in oral stratified squamous epithelium; Clinical implications of multicentric origin. Cancer. 1953. 6:963–968.

8. Goodall J. The origin of epithelial new growths of the ovary. Surg Gynecol Obstet. 1911. 14:584.

9. Lauchlan SC. Conceptual unity of the Mülerian tumor group: A histologic study. Cancer. 1968. 22:601–610.

10. Iioka Y, Tsuchida A, Okubo K, Ogiso M, Ichimiya H, Saito K, et al. Metachronous triple cancers of the sigmoid colon, stomach, and esophagus: Report of a case. Surg Today. 2000. 30:368–371.

11. Cunliffe WJ, Hasleton PS, Tweedle DE, Schofield PF. Incidence of synchronous and metachronous colorectal carcinoma. Br J Surg. 1984. 71:941–943.

12. Kim CK, Chang JW. Multiple primary malignant tumors. J Korean Surg Soc. 1970. 12:63–71.

13. Yun HK, Kim JB. Multiple primary malignant neoplasm. J Korean Surg Soc. 1984. 26:1–9.

14. Koo DJ, Yun DS, Lee JJ, Park CJ. Clinical analysis of 65 multiple primary cancer cases. J Korean Surg Soc. 1999. 56:137–142.

15. Moll UM, Chalas E, Auguste M, Meaney D, Chumas J. Uterine papillary serous carcinoma evolves via a p53-driven pathway. Hum Pathol. 1996. 27:1295–1300.

16. Tashiro H, Isacson C, Levine R, Kurman RJ, Cho KR, Hedrick L. p53 gene mutations are common in uterine serous carcinoma and occur early in their pathogenesis. Am J Pathol. 1997. 150:177–185.

17. Narod SA, Foulkes WD. BRCA1 and BRCA2: 1994 and beyond. Nat Rev Cancer. 2004. 4:665–676.

18. National Comprehensive Cancer Network. NCCN clinical practice guidelines in oncology - Genetic/familial high-risk assessment: Breast and Ovarian. 2005. Fort Washington: National Comprehensive Cancer Network.