A Rare Combination of Synchronous Quadruple Primary Neoplasms: A Case Report and Literature Review

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The prevalence of multiple primary neoplasms (MPNs) is slowly increasing due to prolonged survival of cancer patients with advances in diagnostic and therapeutic modalities. We report an exceptional combination of quadruple primary neoplasms composed of right sided adenocarcinoma of the colon, renal cell carcinoma, teratoma of the ovary, uterine leiomyoma and pre malignant high grade cervix dysplasia. These combinations were not reported before.

Multiple Primary Neoplasms (MPNs) is defined as the occurrence of two or more malignancies in the same individual without any relationship between the tumors either simultaneously or with an interval of time. According to the cancer registries in the national Cancer Institute, cancer survivors had a 14% higher risk of developing a new malignancy than the general population.

A 71-year-old female presented to the emergency department with right lower quadrant colicky abdominal pain and constipation for 2 months. The pain was localized not radiated to the per umbilical area or other abdominal regions. The patient has a history of 15 kg weight loss in the last 6 months. No history of bleeding per rectum, No family history of cancers, No fever, No history of autoimmune disease or LnflDmmDtor\ bowel disease.

This case report has two primary malignant neoplasms in the right colon, right kidney, and a third premalignant dysplasia of the cervix. The patient had liver and spleen metastasis most likely from the colon cancer. It also has two benign tumors in the ovary and myometrium. Surprisingly the ovarian teratoma contained thyroid tissue which can be a cause of occult hyperthyroidism. Unexpected event of our patient that she survived 2 years Dіer successful adjuvant management with a myocardial infarction as an immediate cause of death. Clinician should not only think of recurrence or metastatic lesion in presentation or during follow up period, but also occurrence of second or higher primary lesions in cancer survivors.

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