Synchronous Triple Primary Gastrointestinal Tract Malignancies: A Case Report

Abstract

Multiple primary malignant neoplasms are defined as the occurrence of two or more distinct malignant neoplasms in a single patient. However, synchronous triple primary malignant neoplasms have rarely been reported. We present the case of a 54-year-old male patient who was referred to our outpatient clinic after abnormal findings were detected during upper gastrointestinal endoscopy screening at a local clinic. Comprehensive evaluation using endoscopy, computed tomography, and positron emission tomography led to the simultaneous diagnosis of early gastric, early esophageal, and sigmoid colon cancers. The patient underwent endoscopic submucosal dissection and simultaneous surgical resection of the other two neoplasms. The patient remained without evidence of recurrence or metastasis at the one-year follow-up.

Keywords: Esophageal cancer; Gastric cancer; Sigmoid colon cancer.

Fig. 1.

Gastric cancer findings. A: Endoscopic findings: a raised lesion approximately 1.5 cm in size on the lesser curvature of the gastric body. B: Histopathologic findings: moderately differentiated adenocarcinoma (intestinal type) with invasion into the submucosa (2.5 mm) (H&E stain, ×100). C: A surgical specimen: subtotal gastrectomy with gastrojejunostomy.

Fig. 2.

Esophageal cancer findings. A: Endoscopic findings: a shallow, irregularly depressed lesion approximately 1 cm in size with a nodular surface, located 25 cm from the incisor teeth in the upper esophagus. B: Histopathologic findings: esophageal squamous dysplasia, high-grade (H&E stain, ×100).

Fig. 3.

Positron emission tomography findings: hypermetabolic lesion with increased fluorodeoxyglucose uptake in the sigmoid colon (indicated by the red arrow).

Fig. 4.

Sigmoid colon cancer findings. A: Colonoscopy findings: a mass lesion approximately 4 cm in size located 20 cm above the anal verge in the sigmoid colon. B: A surgical specimen: low anterior resection of the sigmoid colon. C: Surgical histopathologic findings: moderately differentiated adenocarcinoma of the sigmoid colon with invasion into the pericolorectal tissue (H&E stain, ×100).