Metachronous Multiple Primary Malignancies (endometrium and breast): A case report

Ketut Suega , Prayuda Prayuda

Ketut Suega
Hematology-Oncology Division, Internal Medicine Department, Sanglah Hospital/Udayana University. Email:

Prayuda Prayuda
Internal Medicine Department, Sanglah Hospital/Udayana University
Online First: April 15, 2018 | Cite this Article
Suega, K., Prayuda, P. 2018. Metachronous Multiple Primary Malignancies (endometrium and breast): A case report. Bali Medical Journal 7(1): 127-131. DOI:10.15562/bmj.v7i1.867

Introduction: Advanced progression the field of diagnosis and treatment of cancer patients causes increased survival of patients. Increasing life expectancy can lead to new health problems, including Multiple primary malignancies (MPM). Although the incidence of MPM is increasing, the diagnosis of MPM remains very rare. Based on the interval between tumor diagnosis, MPM can be divided into synchronous MPM and metachronous. Studies of MPM may provide useful information not only for clinical purposes but also can provide clues about etiology and management of this type of cancer. This case report was a woman with metachronous MPM (endometrium-breast). Case: A 60-year-old female presented with a lump on the right breast since 2 months before admission. Patients also complained multiple marble sized lumps on the right armpit and right neck since 1 ½ months ago. From previous medical record data (5 years ago), the patient was diagnosed with endometrial carcinosarcoma stage IV. On physical examination on neck showed supraclavicula lymph nodes enlargement. Examination of right mammary region showed Peau d’orange skin with hyperemic colour, and a palpable solid mass. On right axillary region, there was lymph nodes enlargement. Mammae and axilla Ultra Sonography (USG) showed solid malignant in right upper-lateral quadrant breast with diffuse skin edema and multiple solid nodules in right axilla. Mammae histopathologic biopsy results conclusion is invasive carcinoma of no special type grade 3. Conclusion: Our case was a woman with a metachronous MPM endometrial and breast, with the first malignancy was endometrial carcinosarcoma stage IV (type II endometrial carcinoma) followed by the appearance of second malignancy as a breast cancer dextra grade 3 stage IIIC. Time interval between these malignancies more than 6 months (5 years).


Bagri PK, Singh D, Singhal MK, Singh G, Mathur G, Jakhar SL,et al. Double Primary Malignancies: A Clinical & Pathological Analysis Report from a Regional Cancer Institute in India. Iran J Cancer Prev. 2014; 2:66-72.

Chowhan AK, Jena A, Kinnera SB, Patnayak R, Reddy OM, Reddy KM. Dual malignancy: An interesting concurrent mixed epithelial ovarian tumor with esophageal carcinoma. Indian J Cancer. 2011; 48: 361‑2.

Zhu YR. Multiple primary malignant tumors. The J Med Theory Practical. 2006; 19(11):1249–1250.

Reddy PA, Harinarayan CV, Suresh V, Jena A, Chandrasekhar SL, Rashmi P, et al. An unusual case of virilizing ovarian tumor associated with carcinoma in situ of cervix. Int J EndocrinolMetab. 2009; 4: 255‑8.

Lois B, Travis, Bhatia S, James M, Allan M, Kevin C, et al. Second Primary Cancers. In: DeVita VT, Lawrence TS, Rosenberg SA., eds. Cancer Principles & Practice of Oncology. 9th. Philadelphia:Lippincot Williams & Wilkins; 2011. 5141-5180.

Suzuki T, Takahashi H, Yao K, Inagi K, Nakayama M, Makoshi T, et al. Multiple primary malignancies in the head and neck: a clinical review of 121 patients. Acta Otolaryngol Suppl. 2002; (547):88-92.

Irimie A, Cadariu PA, Burz C, Puscas E. Multiple Primary Malignancies – Epidemiological Analysisat a Single Tertiary Institution. J Gastrointestin Dis. 2010; 19(1): 69-73.

Jena A, Patnayak R, Lakshmi AY, Manilal B, Reddy MK. Multiple primary cancers: An enigma. South Asian Journal of Cancer. 2016; 5(1): 29-32

Chaturvedi AK, Engels EA, Gilbert ES. Second cancers among104.760 survivors of cervical cancer: evaluation of long-term risk. JNatl Cancer Inst. 2007; 99: 1634-1643.

Moertel CG, Dockerty MB, Baggenstoss AH. Multiple primary malignant neoplasms. Introduction and presentation of data. Cancer 1961;14:221‑30.

Aydiner A, Karadeniz A, Uygun K. Multiple primaryneoplasms at a single institution: differences between synchronous and metachronousneoplasms. Am J ClinOncol. 2000;23:364-70.

Horii A, Han HJ, Shimada M, Yanagisawa A, Kato Y, Ohta H, et al. Frequent replication errors at microsatellite loci in tumors of patients with multiple primary cancers. Cancer Res. 1994; 54(13): 3373-3375.

Andrea K, Kenney LB, Gilbert ES, Travis LB. Secondary malignancies across the age spectrum. SeminRadiatOncol. 2010; 20(1): 1-20.

Vaslamatzis M, Alevizopoulos N, Petraki. Second primary neoplasms (SPN) in cancer patients. Proc ASCO. 2003; 22: 3581.

Diver EJ, Foster R, Rueda BR, Growdon WB. The Therapeutic Challenge of Targeting HER2 in Endometrial Cancer. The Oncologist. 2015; 20: 1058-1068.

Vogel VG. Identifying and screening patients at risk of second cancers. Cancer Epidemiol Biomarkers Prev. 2006; 15(11): 2027-2032.

Re A, Taylor TH, DiSaia PJ, Anton-Culver H. Risk for breast and colorectal cancers subsequent to cancer of the endometrium in a population-based case series. GynecolOncol. 1997; 66: 255–257.

Katz SJ, Zemencuk JK, Hofer TP. Breast cancer screening in the United States and Canada, 1994: socioeconomic gradients persist. Am J Public Health. 2000; 90: 799–803.

Smith RA, Cokkinides V, Brawley OW. Cancer screening in the United States, 2008: a review of current American Cancer Society guidelines and cancer screening issues. CA Cancer J Clin 2008;58:161–79.

No Supplementary Material available for this article.
Article Views      : 0
PDF Downloads : 0