title: Synchronous quintuple primary gastrointestinal tract malignancies: Case report.
abstract: Multiple primary malignancy is defined as two or more malignancies detected in an individual person. In particular, synchronous quintuple primary malignancy is extremely rare. A 52-year-old male with anal pain and intermittent blood-tinged stool was diagnosed with malignancies in the stomach, jejunum, ascending colon, transverse colon and rectum. He underwent a subtotal gastrectomy, segmental resection of the jejunum and total protocolectomy with end ileostomy. The postoperative pathologic findings were moderate differentiated gastric adenocarcinoma (pT1bN0M0, pStageIA), combined adenocarcinoma and neuroendocrine carcinoma of the jejunum (pT3N0M0, pStageIIA), three mucinous adenocarcinoma of the ascending colon (pT3N0M0, pStageIIA), transverse colon (pT1N0M0, pStageI) and rectum (pT3N1aM0, pStageIIIB). The tumors did not lack MLH-1 and MSH-2 expression, as the markers (bat26, D5S346, bat25, D2S123) suggest MSI-H presence. Adjuvant chemoradiotherapy was started according to regimen, FOLFOX 4 for advanced rectal cancer. Six years post-operation, the patient is currently attending regular follow-ups without recurrence or metastasis.
authors.affiliation: Soo-Hong Kim, Byung-Soo Park, Hyun Sung Kim, Department of Surgery, Pusan National University Yangsan Hospital, Yangsan, Gyungsangnam-do 50612, South Korea.
authors.forename: Soo-Hong
authors.initials: SH
authors.lastname: Kim
authors.affiliation: Soo-Hong Kim, Byung-Soo Park, Hyun Sung Kim, Department of Surgery, Pusan National University Yangsan Hospital, Yangsan, Gyungsangnam-do 50612, South Korea.
authors.forename: Byung-Soo
authors.initials: BS
authors.lastname: Park
authors.affiliation: Soo-Hong Kim, Byung-Soo Park, Hyun Sung Kim, Department of Surgery, Pusan National University Yangsan Hospital, Yangsan, Gyungsangnam-do 50612, South Korea.
authors.forename: Hyun Sung
authors.initials: HS
authors.lastname: Kim
authors.affiliation: Soo-Hong Kim, Byung-Soo Park, Hyun Sung Kim, Department of Surgery, Pusan National University Yangsan Hospital, Yangsan, Gyungsangnam-do 50612, South Korea.
authors.forename: Jae Hun
authors.initials: JH
authors.lastname: Kim
mesh_terms: D002288:Adenocarcinoma, Mucinous / Q000175:diagnosis* / Q000235:genetics / Q000473:pathology / Q000628:therapy; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D014408:Biomarkers, Tumor / Q000032:analysis; D000072716:Cancer Pain / Q000209:etiology; D059186:Chemoradiotherapy, Adjuvant; D003082:Colectomy; D003110:Colonic Neoplasms / Q000175:diagnosis* / Q000235:genetics / Q000473:pathology / Q000628:therapy; D016099:Endoscopy, Gastrointestinal; D005472:Fluorouracil / Q000627:therapeutic use; D005743:Gastrectomy / Q000379:methods; D006471:Gastrointestinal Hemorrhage / Q000209:etiology; D006801:Humans; D007081:Ileostomy; D007580:Jejunal Neoplasms / Q000175:diagnosis* / Q000235:genetics / Q000473:pathology / Q000628:therapy; D002955:Leucovorin / Q000627:therapeutic use; D008297:Male; D053842:Microsatellite Instability; D008875:Middle Aged; D009367:Neoplasm Staging; D009378:Neoplasms, Multiple Primary / Q000175:diagnosis* / Q000235:genetics / Q000473:pathology / Q000628:therapy; D009944:Organoplatinum Compounds / Q000627:therapeutic use; D000072078:Positron Emission Tomography Computed Tomography; D012004:Rectal Neoplasms / Q000175:diagnosis* / Q000235:genetics / Q000473:pathology / Q000628:therapy; D013274:Stomach Neoplasms / Q000175:diagnosis* / Q000235:genetics / Q000473:pathology / Q000628:therapy; D014057:Tomography, X-Ray Computed
chemical_list: D014408:Biomarkers, Tumor; D009944:Organoplatinum Compounds; D002955:Leucovorin; D005472:Fluorouracil
keywords: Colon neoplasm; Small bowel neoplasm; Stomach neoplasm; Synchronous quintuple primary cancer