title: An elderly woman with triple primary metachronous malignancy: A case report and review of literature.
abstract: BACKGROUND
  Prevalence of multiple primary malignancies is slowly increasing due to prolonged survival of cancer patients with advances in diagnostic and therapeutic modalities. The reasons may be environmental modifications, genetic predisposition or therapy induced. We describe a case of a 64-year-old woman with three different metachronous primary malignancies managed at our center since 4 years.
  
  
  METHODS
  First primary diagnosed in our patient was adenocarcinoma of small intestine which is a rare gastrointestinal malignancy. For this she underwent surgical resection followed by chemotherapy. After 21 months she developed infiltrating duct carcinoma of breast which was managed with modified radical mastectomy and chemotherapy. Again after latent period of 10 months patient had papillary adenocarcinoma of ovary for which she was administered chemotherapy. During follow up tumor was found to be chemoresistant and again she underwent cytoreductive surgery followed by chemotherapy.
  
  
  CONCLUSIONS
  In present case patient did not have significant risk factors for development of carcinoma of small intestine, breast and ovary. Our patient underwent surgical excision three times and received total 16 chemotherapy cycles of different regimens during management of all three primary malignancies. Development of second and higher order primary malignancy after successful management of previous one should be always kept in mind.
  
  
  CONCLUSIONS
  Awareness, suspicion of multiple primary malignancy and aggressive diagnostic work up plays crucial role in their detection at earlier stage for better outcome. In addition choice of appropriate chemotherapeutic agents and their regimens remains the cornerstone while managing the patients with multiple primary malignancies.
authors.affiliation: Kodlikeri Memorial Hospital & CIIGMA Hospital, Aurangabad 431005, India.
authors.forename: Unmesh
authors.initials: U
authors.lastname: Takalkar
authors.forename: Balaji N
authors.initials: BN
authors.lastname: Asegaonkar
authors.forename: Pushpa
authors.initials: P
authors.lastname: Kodlikeri
authors.forename: Shilpa
authors.initials: S
authors.lastname: Asegaonkar
authors.forename: Brijmohan
authors.initials: B
authors.lastname: Sharma
authors.forename: Suresh H
authors.initials: SH
authors.lastname: Advani