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

Metachronous Four Primary Malignancies in Gastro-intestinal Tract

  • 1Department of Surgery, Yeungnam University College of Medicine, Daegu, Korea. swkim@med.yu.ac.kr


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.


Multiple primary malignancy; Gastro-intestinal tract

MeSH Terms

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


  • 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).


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