Quadruple metachronous malignancy in a single patient with multiple sclerosis: case report
M. Buta1, Z. Milovanovic1, D. Lavrnic2,3, I. Djurisic1, M. Oruci1, G. Pupic1 & R. Dzodic1,3
Introduction: Quadruple primary malignancies occur with an incidence of <0.1% and <100 cases have been published to our best knowledge. We are presenting a patient with multiple sclerosis and triple thyroid carcinoma, double melanoma and a breast cancer.
Case report: Over the course of 4 years we treated a single patient due to stage III (T3, N1a, M0) medullary thyroid carcinoma size 45 mm in the right lobe and two micropapillary carcinomas in the left lobe, 1.24 mm thick scapular melanoma (Clark II, Breslow II) and 0.85 mm thick lumbar melanoma (Clark II, Breslow II) with negative sentinel node, lobular invasive 4 mm breast carcinoma with clear resectional margins and negative nodes followed by 20 mg tamoxifen daily. FDGPET scan peformed 1 month ago was negative, CA 153 level was within normal values and calcitonin level was 83 ng/l. There are no signs of disease reccurence. From 1980 to 2011 only 89 cases of primary quadruple malignancy have been reported. The number of multiple malignancies report is slowly but gradually increasing.
Conclusion: Quadruple malignancy is a rare phenomenon in medicine and most cases of multiple malignancies affect one organ in a female patient. Our patient had family history of malignancy on mothers and fathers side (father, grandmother and uncle). She has not received chemotherapy with alkylating agents which are well known cause of secondary cancers. The patient received mitoxanthrone, drug extensively used as a disease-modifying therapy for multiple sclerosis. However, this treatment could be linked to non-malanocytic skin tumors and increased susceptibility to develop acute promyelocytic leukemia.
Further studies and closer clinical attention is needed to clarify the relation between secondary malignancies, applied treatment and endogenous and exogenous carcinogens.
Declaration of interest: The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project.
Funding: This research did not receive any specific grant from any funding agency in the public, commercial or not-for-profit sector.