title: Primary multiple tumor with affection of the thyroid gland, uterus, urinary bladder, mammary gland and other organs.
abstract: BACKGROUND
  Nowadays multiple primary tumor is characterized by growth and development of two or more tumors in one patient. The total world sickness rate ranges from 1% to 37%. The presence of four or more tumors in one patient is rare case and presented as casuistry.
  
  
  METHODS
  We showed a case of multiple primary tumor with metahronic lesion of the thyroid, uterus and breast, followed by synchronous benign tumors of the subcutaneous fat, urinary bladder and gallbladder were considered. The development of all malignant tumors in all cases was accompanied by the presence of benign precancerous processes. Analysis of neoplasia histology shows the predominance of poorly differentiated forms of cancers in women with increased aggressiveness of cancerous tissue in each subsequent case and the growth of metastatic ability. The influence of heredity on the tumors progress is confirmed by immunohistochemical characteristics of cancer cells. Steroid-sensitive tissue of the uterus and breast in both cases didn't express ER and PR, in all cases the tissue had overexpression of Ki-67, p53, bax and bcl-2 receptors. The results of DNA testing for determination the Lynch syndrome revealed the presence of microsatellite instability in genetic material. The results of studies revealed the absence of mutations in these genes (MLH1, MSH2 and MSH6). Despite the negative results of the study, it doesn't exclude the possibility of Lynch syndrome for 100%, and its presence may be caused by the mutations of other genes (PMS1, PMS2 and MLH3), responsible for DNA repair. Unfortunately there wasn't any opportunity to study their mutations.
  
  
  CONCLUSIONS
  While studying the anamnesis of life and disease of women it was revealed that she had multiple primary tumor with lesions of the breast, urinary bladder, thyroid, uterus and other organs. This study shows that neoplastic tissue in all cases had high rates of cell proliferation, their antiapoptotic stability, expression of prognostically unfavorable-receptors, and absence of favorable prognostic markers. Histological study revealed high rates of malignant neoplastic tissue. It indicates to the existence of common mechanisms of malignant tumors and their genetic predisposition that can be clearly observed in many generations of patient.
authors.affiliation: Sumy State University, Department of Pathology, Ukraine. Electronic address: pathomorph@gmail.com.
authors.forename: А
authors.initials: А
authors.lastname: Romaniuk
authors.affiliation: Sumy State University, Department of Pathology, Ukraine. Electronic address: n.lyndin@med.sumdu.edu.ua.
authors.forename: M
authors.initials: M
authors.lastname: Lyndin
authors.affiliation: Sumy State University, Ukraine. Electronic address: v.smiyanov@med.sumdu.edu.ua.
authors.forename: V
authors.initials: V
authors.lastname: Smiyanov
authors.affiliation: Sumy State University, Department of Pathology, Ukraine. Electronic address: vlad-sikora@ukr.net.
authors.forename: Vl
authors.initials: V
authors.lastname: Sikora
authors.affiliation: Sumy State University, Department of Pathology, Ukraine. Electronic address: a.reznik@med.sumdu.edu.ua.
authors.forename: A
authors.initials: A
authors.lastname: Rieznik
authors.affiliation: Sumy State University, Department of Pathology, Ukraine. Electronic address: kuzenko_yevhen@rambler.ru.
authors.forename: Y
authors.initials: Y
authors.lastname: Kuzenko
authors.affiliation: Sumy State University, Department of Pathology, Ukraine. Electronic address: ay.budko@med.sumdu.edu.ua.
authors.forename: H
authors.initials: H
authors.lastname: Budko
authors.affiliation: Sumy State University, Department of Orthopedics, Traumatology and Emergency Conditions, Ukraine. Electronic address: yl.moskalenko@med.sumdu.edu.ua.
authors.forename: Yu
authors.initials: Y
authors.lastname: Moskalenko
authors.affiliation: Sumy State University, Department of Pathology, Ukraine. Electronic address: l.karpenko@med.sumdu.edu.ua.
authors.forename: L
authors.initials: L
authors.lastname: Karpenko
authors.affiliation: Sumy State University, Surgery Department with Pediatric Surgery and Urology, Ukraine. Electronic address: v.sikora@med.sumdu.edu.ua.
authors.forename: Vol
authors.initials: V
authors.lastname: Sikora
authors.affiliation: Sumy State University, Foreign Languages Department, Ukraine. Electronic address: oksanagl123@gmail.com.
authors.forename: O
authors.initials: O
authors.lastname: Gladchenko
mesh_terms: D049109:Cell Proliferation; D003123:Colorectal Neoplasms, Hereditary Nonpolyposis / Q000175:diagnosis* / Q000235:genetics / Q000473:pathology; D004260:DNA Repair / Q000235:genetics; D005260:Female; D020022:Genetic Predisposition to Disease; D006801:Humans; D053842:Microsatellite Instability; D008875:Middle Aged; D009154:Mutation; D009378:Neoplasms, Multiple Primary / Q000175:diagnosis* / Q000235:genetics / Q000473:pathology; D013964:Thyroid Neoplasms / Q000175:diagnosis* / Q000235:genetics / Q000473:pathology; D001749:Urinary Bladder Neoplasms / Q000175:diagnosis* / Q000235:genetics / Q000473:pathology; D014594:Uterine Neoplasms / Q000175:diagnosis* / Q000235:genetics / Q000473:pathology
keywords: Bladder; Breast; Cancer; Case report; Lynch syndrome; Multiple primary tumor; Thyroid; Uterus