Four Malignancies - One Patient

Case Report

Ann Hematol Oncol. 2014;1(3): 1015.

Four Malignancies - One Patient

Kenyeres A1*, Kovács G1, Barna S2, Bedekovics J3, Méhes G3, Illés A1 and Miltényi Z1

1Department of Hematology, University of Debrecen, Hungary

2Scanomed LTD, University of Debrecen, Hungary

3Department of Pathology, University of Debrecen, Hungary

*Corresponding author: Kenyeres A, Department of Hematology, University of Debrecen, 4032 Debrecen, Nagyerdeikrt. 98, Hungary

Received: November 21, 2014; Accepted: December 05, 2014; Published: December 08, 2014


Introduction: Cancer survivors have an increased risk of developing further malignancies. Their development is affected by many facilitating factors, and they can occur metachronously or synchronously with the other neoplasms.

Case Report: Our patient was an elderly man, who developed four primary malignancies. He had intraepithelial neoplasia of the prostate at the age of 70. Five years later, he presented with Kaposi sarcoma of skin. At 84 years of age he developed synchronous stadium IV peripheral T-cell lymphoma and adenocarcinoma of the colon.

Discussion: There are different studies and theories about correlation between occurrence of lymphoid malignancies and other tumors, and it is likely that malignancies of lymphoid cells are high risk factors for developing second neoplasms.

Keywords: Multiple primary neoplasms; T-cell lymphoma; Gastrointestinal adenocarcinoma; PET/CT


CHOP: Cyclophosphamide Hydroxidaunorubicin Oncovin Prednisone; ECOG: Eastern Cooperative Oncology Group; HE: Hematoxylin-Eosin; MPMN: Multiple Primary Malignant Neoplasm; NHL: Non-Hodgkin's Lymphoma; PET/CT: Positron Emission Tomography - Computed Tomography


The number of cancer survivors is increasing with progress of medical treatment, but these patients have higher risk for development of a second or higher order primary cancer [1]. Multiple Primary Malignant Neoplasms (MPMNs) are defined as distinct tumors, presenting a definite pattern of malignant disease, and the possibility that one of the tumors is a metastasis of another is excluded [1]. According to literature roughly 2-12% of all patients with two metachronous or synchronous tumors go on to develop a third or fourth neoplasm [2]. Another study estimated the incidence of secondary malignant tumors to be 3-5%, while occurrence of triple tumors is 0,5%, and that of quadruple tumors 0,3% [1]. Proposing factors include prior cancer treatment, environmental agents, immune abnormalities and genetic predisposition [1,3,4]. Majority of MPMNs are carcinomas, and they occur in the same, or in paired organs, and in embriologically related organs [1,5]. MPMNs can be divided according to interval between presentation of the tumors. Cancers are considered to be synchronous when they are diagnosed simultaneously or within six months of each other, while metachronous cancers are defined when the second is diagnosed more than six months after the first [6].

Case Presentation

The patient is a male born in 1928. He was treated twice because of deep venous thrombosis in 1997 and 1998. Searching for the background of thrombi, further investigation revealed stage II intraepithelial neoplasia of the prostate. The patient underwent total androgenic blockade monotherapy for four years. In 2003, a 4x3 mm brownish black nodule was completely excised from the skin of the right thigh, which histologically proved classic type Kaposi sarcoma. He was HIV negative; he received no additional therapy following surgery. Chronic renal failure developed in 2006 and Hemodialysis was started in 2010. In August of 2012 he presented with strong bleeding from a lesion of the left forearm 4-5 cm in diameter which first appeared 1,5 years earlier. Biopsy was performed and histology revealed cutaneous manifestation of T-cell Non-Hodgkin's Lymphoma (NHL) (Figure 1). At the same time he complained of itching and nocturnal sweats. Staging including flowcytometry from peripheral blood and bone marrow, cristal biopsy and PET/CT, revealed stadium IV/A disease, International Prognostic Index (IPI) 4, high risk, ECOG 1.