From Leukemia to Solid Tumors, Successful Multidisciplinary Management of Three Distinct Primary Cancers in a Single Patient - A Case Report

Sep 22, 2026

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A 41-year-old man developed three distinct primary malignancies—acute myeloid leukemia, male breast cancer, and metastatic colorectal cancer—within 7 years. This rare case highlights the evolving challenge of multiple primary cancers and demonstrates how coordinated multidisciplinary care can preserve curative intent despite successive life-threatening diagnoses. The report emphasizes diagnostic interval differences and the complexity of biological, environmental, and treatment-related contributors to metachronous disease evolution.

LanguageEnglish

CategoryHealthcare

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Pages5

Reading Time13 min

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Introduction

Multiple primary malignancies: definitions and classification

Clinical Case Report

Case history

Key clinical message

Clinical Case Reports CASE REPORT OPEN ACCESS From Leukemia to Solid Tumors, Successful Multidisciplinary Management of Three Distinct Primary Cancers in a Single Patient: A Case Report Abolfazl Khalafi-Nezhad1 | Nazanin Alemzadeh1 | Mohammad Hossein Anbardar2 | Zahra Ghanbarinasab1 1Department of Hematology, Medical Oncology and Stem Cell Transplantation, Hematology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran | 2Department of Pathology, Shiraz University of Medical Science, Shiraz, Iran Correspondence: Nazanin Alemzadeh ([nazaninalemzadeh1374@gmail.com](nazaninalemzadeh1374@gmail.com)) Received: 4 April 2026 | Revised: 7 May 2026 | Accepted: 20 May 2026 Keywords: metachronous cancers | multidisciplinary cancer management | multiple primary malignancies | triple primary malignancy | ABSTRACT
A 41-year-old man developed three distinct primary malignancies—acute myeloid leukemia, male breast cancer, and metastatic colorectal cancer—within 7 years. This rare case highlights the evolving challenge of multiple primary cancers and demonstrateshow coordinated multidisciplinary care can preserve curative intent despite successive life-threatening diagnoses. | | | --- | --- | | 1 | Introduction | synchronous malignancies are identified within 6 months of the initial diagnosis, whereas metachronous malignancies are de- | | In the evolving landscape of modern oncology, the rising prevalence of multiple primary malignancies, specifically meta- | tected after a period exceeding 6 months [2] . | | chronous cases, has emerged as a significant clinical challenge. | Although the reported incidence of multiple primary cancers | | This trend reflects advances in diagnostic precision, improved | differs across populations, an overall increase has been consis- | | surveillance, and the development of novel therapeutic mo- | tently observed. Their development is thought to arise from a | | dalities—including chemotherapy, radiotherapy, and targeted | complex interplay of host-and tumor-related factors, including | | agents. Although these advances have meaningfully extended | genomic instability, epigenetic changes, immune dysregulation, | | patient survival, prolonged survivorship has also increased the | hormonal imbalance, and alterations in the tumor microen- | | risk of subsequent primary neoplasms [1] . | vironment. In addition, disruption of key signaling pathways, such as epidermal growth factor receptor (EGFR), as well as the | | The concept of multiple primary malignancies was first de- | presence of circulating tumor DNA, has been implicated in their | | scribed by Warren and Gates in 1932, marking a significant milestone in the understanding of cancer biology. According to their | pathogenesis [3] . | | established criteria, these malignancies are characterized by the | Beyond these biological mechanisms, a range of environmental | | occurrence of two or more histologically distinct tumors, each | and lifestyle-related factors also contribute to the risk of devel- | | confirmed as malignant and arising independently, rather than | oping multiple malignancies. Inherited genetic susceptibility, | | representing metastatic spread from a single primary source. | advanced age, obesity, and tobacco use have all been recognized | | Classification is based on the interval between diagnoses: | as important contributors [4] . | | Abbreviations: AML, acute myeloid leukemia; CT, computed tomography; EGFR, epidermal growth factor receptor; FLAG regimen, fludarabine, high-dose
cytarabine, and granulocyte colony-stimulating factor; FOLFOX regimen, 5-fluorouracil, leucovorin, and oxaliplatin; TC regimen, docetaxel and cyclophosphamide. | | | This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
© 2026 The Author(s). Clinical Case Reports published by

FAQs

What three malignancies were diagnosed in this patient, and over what time span?

The patient developed acute myeloid leukemia, male breast cancer, and metastatic colorectal cancer within 7 years.

How does the article distinguish metachronous from synchronous malignancies?

Synchronous malignancies are identified within 6 months of the initial diagnosis, while metachronous malignancies are detected after a period exceeding 6 months.

Why is multidisciplinary management emphasized in this case?

Coordinated multidisciplinary decision-making and individualized management, guided by molecular profiling, are presented as enabling successful long-term outcomes while maintaining curative intent.

Sep 22, 2026

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