Korean J Gastroenterol.  2009 Jun;53(6):373-377. 10.4166/kjg.2009.53.6.373.

Metachronous Four Primary Malignancies in Gastro-intestinal Tract

• Bae JM
• Kim SW
• Kim SW
• Song SK

• KMID: 1792755
• DOI: http://doi.org/10.4166/kjg.2009.53.6.373

Abstract

Multiple primary malignancy was reported firstly by Billroth in 1889. Recently, multiple primary malignancies are considered to increase due to improved survival rate of cancer patients, advanced diagnostic tools, and increased use of chemotherapy and radiotherapy. In Korea, several cases of triple primary malignancies were reported. However, four primary malignancies in gastro-intestinal tract was rarely reported. Recently, we experienced a 70 year-old male who was diagnosed with metachronous four primary malignancies in rectum, ascending colon, stomach, and ampulla of Vater. We report this rare case of metachronous four primary malignancies with a review of literature.

Keyword

Multiple primary malignancy; Gastro-intestinal tract

MeSH Terms

Adenocarcinoma/*diagnosis/pathology/surgery
Adenocarcinoma, Mucinous/diagnosis/surgery
Aged
Ampulla of Vater/*pathology
Colonic Neoplasms/diagnosis/surgery
Common Bile Duct Neoplasms/*diagnosis/pathology/surgery
Gastrointestinal Neoplasms/*diagnosis/pathology/radiography
Humans
Male
Neoplasms, Second Primary/*diagnosis/pathology
Rectal Neoplasms/diagnosis/surgery
Stomach Neoplasms/diagnosis/pathology/surgery
Tomography, X-Ray Computed

Figure

• 

  Fig. 1. Gastroduodenoscopic finding showed ulcerative mass of anterior wall of gastric antrum (arrow).

• 

  Fig. 2. (A) Duodenoscopic finding showed reddish and edematous mucosal change of ampulla of Vater (arrow). (B) Pathologic examination of ampulla of Vater revealed adenocarcinoma (arrow head) (H&E, ×100).

• 

  Fig. 3. Abdominal CT findings. (A) There was diffuse dilatation of intrahepatic bile ducts (arrow). (B) Common bile duct also showed dilatation (arrow head).

Reference

1. Billroth T. Die allgemeine chirurgische pathologie und ther-apie in 51 Vorlesungen: ein handbuch fur Studirende und Arzte, 14 Aufl. Berlin, Germany G. Reimer. 1889.

2. Warren S, Gates O. Multiple primary malignant neoplasm. Cancer. 1932; 16:1358.

3. Bordin GM, Key CR, McQuade CE, Kutvirt DM, Hughes WB, Brylinski DA. Multiple primary cancers. Relative risk in New Mexico's triethnic population. Cancer. 1977; 40(suppl 4):1793–1800.

4. Stalker LK, Phillips RB, Pemberton J. Multiple primary malignant lesions. Surg Gynecol Obstet. 1939; 68:595.

5. Moertel CG, Dockerty MB, Baggenstoss AH. Multiple primary malignant neoplasms. Cancer. 1961; 14:221–230.

6. Li FP. Second malignant tumors after cancer in childhood. Cancer. 1977; 40(suppl 4):1899–1902.

7. Sieber SM, Adamson RH. Some comments on the potential carcinogenicity of the clinically useful antitumor agents. Cancer. 1977; 40(suppl 4):1950–1951.

8. Horri A, Han HJ, Shimada M, et al. Frequent replication er-rors at microsatellite loci in tumors. Cancer Res. 1994; 54:3373–3375.

9. Cheng HY, Chu CH, Chang WH, et al. Clinical analysis of multiple primary malignancies in the digestive system: a hospital-based study. World J Gastroenterol. 2005; 11:4215–4219.

10. Coleman MP. Multiple primary malignant neoplasms in England and Wales, 1971-1981. Yale J Biol Med. 1986; 59:517–531.

11. Levi F, Randimbson L, Te VC, Rolland-Portal I, Franceschi S, La Vecchia C. Multiple primary cancers in the Vaud Cancer Registry, Switzerland, 1974-89. Br J Cancer. 1993; 67:391–395.

12. Tsukuma H, Fujimoto I, Hanai A, Hiyama T, Kitagawa T, Kinoshita N. Incidence of second primary cancers in Osaka residents, Japan, with special reference to cumulative and relative risks. Jpn J Cancer Res. 1994; 85:339–345.

13. Frodin JE, Ericsson J, Barlow L. Multiple primary malignant tumors in a national cancer registry-reliability of reporting. Acta Oncol. 1997; 36:465–469.

14. Youn SI, Park YG, Chi KC, Lee JH, Lim HM, Kim SJ. Metachronous tripple primary malignant neoplasm. J Korean Surg Soc. 2005; 69:83–87.

15. Cha SW, Ahn CJ, Kim JG, et al. Metachronous triple primary cancers. J Korean Surg Soc. 2004; 67:422–427.

16. Kang JH, Lee KH, Lee SM, Ko YK, Hong SH, Yoon C. 2 Cases of metachronous triple primary cancers. J Korean Soc Coloproctol. 2000; 16:119–124.

17. Hong SW, Nah YW, Kang YK, Lee HS. A case of four metachronous primary malignant tumors. Inje Med J. 1999; 20:553–557.

18. Son WY, Wang HJ, Suh KW, Kim MW. Four primary cancers in abdominal cavity. J Korean Surg Soc. 1997; 53:921–926.

19. Cleary JB, Kazarian KK, Mersheimer WL. Multiple primary cancer: thirty patients with three or more primary cancers. Am J Surg. 1975; 129:686–690.