A case of quintuplicate malignancies: Simultaneous endometrial and ovarian followed by renal, colorectal and breast cancers spanning over 9 years

Abstract

　Multiple Primary malignancies are defined as two or more independent cancers occuring in the same person simultaneously or metachronously. The number of reports is increasing, but remain rare. Here we report a case of 5 MPMs: during the postoperative observation period of double cancers (endometrial and ovarian), three more cancers developed in the kidney, in the colorectal and in the breast. The case was a 75y/o woman. At the age of 64, she was diagnosed with endometrial cancer and underwent surgery. Postoperative pathological examination then revealed double cancers of endometrial and ovarian cancers. She was diagnosed with renal, colon and breast cancer around 5, 7 and 8 years after the first operation. Immunohistochemistry (IHC) of mismatch repair (MMR) proteins was examined as supportive diagnosis of Lynch syndrome, but no loss of expression was observed. According to the Hereditary breast–ovarian cancer syndrome (Hereditary Breast and Ovarian cancer: HBOC) diagnostic criteria, germline BRCA1/2 gene test was performed but no pathogenic variant was detected. Patients with MPMs have a high rate of detecting pathological mutations in hereditary tumor genes. Clinical genetic specialist might play a key role for the management of those patients.