title: One patient--three head and neck primaries: nasopharyngeal, tongue and thyroid cancers.
abstract: BACKGROUND
  We report a rare case of three head and neck malignancies in one patient. Squamous cell carcinoma of tongue and papillary thyroid carcinoma occurred as metachronous cancers in a patient with primary nasopharyngeal carcinoma. These three pathologically distinct malignancies of head and neck region in one patient is a rare phenomenon and is not reported so far.
  
  
  METHODS
  A 60 year old Saudi female patient presented in March 2011 with locally advanced nasopharyngeal carcinoma. After completion of concurrent chemoradiation in June 2011, she developed two new primaries i-e thyroid cancer and tongue cancer in May 2012 along with recurrent nasopharyngeal carcinoma. We discuss histopathologic features, diagnostic tools and treatment modalities for this rarely existing case.
  
  
  CONCLUSIONS
  High index of suspicion and thorough work up is essential in follow up of patients with head and neck primary cancers. The effect of field cancerization and environmental factors need to be explored in greater depths in such selected cases. However, which patients are at increased risk of triplet primaries, is still unknown.
authors.affiliation: Department of Radiation Oncology, King Fahad Medical City, Riyadh 11525, Saudi Arabia. mfareed@kfmc.med.sa.
authors.forename: Muhammad Mohsin
authors.initials: MM
authors.lastname: Fareed
authors.forename: Abdullah
authors.initials: A
authors.lastname: Al Amro
authors.forename: Yasser
authors.initials: Y
authors.lastname: Bayoumi
authors.forename: Khalid H A
authors.initials: KH
authors.lastname: AlQahtani
authors.forename: Hanadi A
authors.initials: HA
authors.lastname: Fatani
authors.forename: Mutahar Ali
authors.initials: MA
authors.lastname: Tunio
authors.forename: Farhan
authors.initials: F
authors.lastname: Khalid
mesh_terms: D002277:Carcinoma / Q000000981:diagnostic imaging / Q000473:pathology* / Q000532:radiotherapy; D002291:Carcinoma, Papillary; D005260:Female; D005720:Gamma Rays; D006257:Head / Q000473:pathology / Q000528:radiation effects; D006801:Humans; D008875:Middle Aged; D000077274:Nasopharyngeal Carcinoma; D009303:Nasopharyngeal Neoplasms / Q000473:pathology* / Q000532:radiotherapy; D009333:Neck / Q000473:pathology / Q000528:radiation effects; D009364:Neoplasm Recurrence, Local / Q000473:pathology* / Q000532:radiotherapy; D009378:Neoplasms, Multiple Primary / Q000473:pathology* / Q000532:radiotherapy; D011877:Radionuclide Imaging; D000077273:Thyroid Cancer, Papillary; D013961:Thyroid Gland / Q000000981:diagnostic imaging / Q000473:pathology / Q000528:radiation effects; D013964:Thyroid Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology* / Q000532:radiotherapy; D014059:Tongue / Q000473:pathology / Q000528:radiation effects; D014062:Tongue Neoplasms / Q000473:pathology* / Q000532:radiotherapy; D016896:Treatment Outcome