Quadruple Metachronous Malignancy in a Single Patient with Multiple Sclerosis

Quadruple primary malignancies occur with an incidence of less than 0.1%. Only less than hundred cases have been published until today. The number of multiple malignancies reported is gradually increasing. Here, we present a female patient with a multiple sclerosis and quadruple cancers from different embryological origin. The patient had medullary thyroid carcinoma (stage III-T3, N1a, M0) and multicentric micropapillary carcinomas, two melanomatous lesions, 1.24 and 0.85 mm thick (Clark II, Breslow II) and breast cancer (T1a, N0, M0). There were no signs of disease recurrence during the 5 years including the exam performed last month. Further genomic studies and closer clinical attention are needed to clarify the relation between secondary malignancies, applied treatments and endogenous and exogenous carcinogens in the process of carcinogenesis in quadruple malignancies.