title: Triple synchronous invasive malignancies of the female genital tract in a patient with a history of leukemia: A case report and review of the literature.
abstract: BACKGROUND
  Three primary synchronous cancers in the female genital tract are extremely rare. In the literature, only four studies have described three different invasive gynecologic cancers of epithelial origin identified simultaneously in the same patient.
  
  
  METHODS
  This is the first case in the literature that reports on triple primary ovarian, endometrial and endocervical cancers in a 38-year-old woman with a history of previously treated malignant disease (acute lymphatic leukemia). With a preoperative diagnosis of endocervical adenocarcinoma stage Ib1 (according to International Federation of Gynecology and Obstetrics-FIGO), as well as an adnexal mass, she underwent radical hysterectomy with bilateral adnexectomy. Pathologic examination of the surgical specimen revealed a mucinous adenocarcinoma of the cervix, an endometrioid adenocarcinoma of the uterine corpus, and a mucinous adenocarcinoma of the left ovary. Eighteen months after appropriate treatment, the patient is free of disease.
  
  
  CONCLUSIONS
  The incidental diagnosis of more than one tumor is often a post-operative finding, usually with the detection of low-stage neoplasms. Multiple synchronous gynecologic cancers have a better prognosis than metastatic or advanced primitive disease. In a patient with multiple neoplasms, the prognosis is determined by the tumor with the worst prognosis.
authors.affiliation: Department of Gynecologic Oncology, Centro di Riferimento Oncologico-National Cancer Institute, 33081 Aviano, Pordenone, Italy.
authors.forename: Benito
authors.initials: B
authors.lastname: Chiofalo
authors.affiliation: Department of Gynecologic Oncology, Centro di Riferimento Oncologico-National Cancer Institute, 33081 Aviano, Pordenone, Italy.
authors.forename: Jacopo
authors.initials: J
authors.lastname: Di Giuseppe
authors.affiliation: Department of Pathology, Centro di Riferimento Oncologico-National Cancer Institute, 33081 Aviano, Pordenone, Italy.
authors.forename: Lara
authors.initials: L
authors.lastname: Alessandrini
authors.affiliation: Department of Pathology, Centro di Riferimento Oncologico-National Cancer Institute, 33081 Aviano, Pordenone, Italy.
authors.forename: Tiziana
authors.initials: T
authors.lastname: Perin
authors.affiliation: Department of Gynecologic Oncology, Centro di Riferimento Oncologico-National Cancer Institute, 33081 Aviano, Pordenone, Italy.
authors.forename: Giorgio
authors.initials: G
authors.lastname: Giorda
authors.affiliation: Department of Pathology, Centro di Riferimento Oncologico-National Cancer Institute, 33081 Aviano, Pordenone, Italy.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Canzonieri
authors.affiliation: Department of Gynecologic Oncology, Centro di Riferimento Oncologico-National Cancer Institute, 33081 Aviano, Pordenone, Italy. Electronic address: fsopracordevole@cro.it.
authors.forename: Francesco
authors.initials: F
authors.lastname: Sopracordevole
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology* / Q000601:surgery; D002288:Adenocarcinoma, Mucinous / Q000473:pathology / Q000601:surgery; D000328:Adult; D016889:Endometrial Neoplasms / Q000473:pathology* / Q000601:surgery; D005260:Female; D006801:Humans; D009378:Neoplasms, Multiple Primary / Q000473:pathology* / Q000601:surgery; D010051:Ovarian Neoplasms / Q000473:pathology* / Q000601:surgery; D016896:Treatment Outcome; D002583:Uterine Cervical Neoplasms / Q000473:pathology* / Q000601:surgery
keywords: Cervical cancer; Endometrial cancer; Ovarian cancer; Synchronous malignancies; Triple cancer