title: Simultaneous quadruple carcinoma of colon Case report and literature review.
abstract: BACKGROUND
  Multiple primary malignancies can arise in the large bowel as simultaneous, synchronous and/or metachronous. All tumors must be distant from each other to be considered as primitive, none have to be the result of metastasis from other tumors.
  
  
  METHODS
  We present a case of a 71 years old woman who was admitted to our hospital for a 3-year history of not well defined abdominal pain and hematochezia. The patient had no family history of cancer. Colonoscopy revealed 4 simultaneous tumors located at 4 and 20 cm from the ileocecal valve and at 23,2 and 19 cm from the anal verge. At CT scan there were no distant metastases, neither lymphonode node involvement. A quadruple adenocarcinoma of the colon was confirmed by the pathologist. Patient was operated on total colectomy with ileo-rectal anastomosis.
  
  
  CONCLUSIONS
  Two or three synchronous tumors of the colon have been already described in literature in about 1,8-14% of cases, but the presence of four simultaneous cancers, as in our case, is very interesting and unusual without an history of FAP or familiar cancer.
  
  
  CONCLUSIONS
  Comprehensive preoperative study, extensive intraoperative exploration, and radical resection can improve surgical results and survival rate, remaining unquestioned the cause.
authors.forename: Nicola
authors.initials: N
authors.lastname: Carlomagno
authors.forename: Armando
authors.initials: A
authors.lastname: Calogero
authors.forename: Michele
authors.initials: M
authors.lastname: Saracco
authors.forename: Michele
authors.initials: M
authors.lastname: Santangelo
authors.forename: Concetta
authors.initials: C
authors.lastname: Dodaro
authors.forename: Andrea
authors.initials: A
authors.lastname: Renda
mesh_terms: D000230:Adenocarcinoma / Q000150:complications / Q000473:pathology* / Q000601:surgery*; D000368:Aged; D000714:Anastomosis, Surgical; D003082:Colectomy / Q000379:methods; D003110:Colonic Neoplasms / Q000150:complications / Q000473:pathology* / Q000601:surgery*; D003113:Colonoscopy; D005260:Female; D006801:Humans; D009378:Neoplasms, Multiple Primary / Q000150:complications / Q000473:pathology* / Q000601:surgery*; D016896:Treatment Outcome