Akhtar, M H B

Abstract Introduction Multiple Primary Malignancies (MPMs) are characterized by the presence of at least two distinct primary malignancies in a patient. The occurrence rate of MPMs is between 1.63% and 10.9% across articles. To our knowledge, this combination of tumours has not been documented in the existing literature. Case: A 44-year-old male, presented with complaints of abdominal pain, chronic constipation, and multiple episodes of bleeding per rectum for one month. Colonoscopy showed proliferative irregular growth at junction of recto-sigmoid colon; Biopsy showed well-differentiated adenocarcinoma. CT scan abdomen and MRI pelvis showed focal eccentric thickening at the rectosigmoid region and enhancing, partly exophytic left renal mass 3.6 x 2.2 x 2.0 cm from the lower pole, another exophytic soft tissue nodule 2.2 x 1.6 x 1.9 cm on inferior surface of body of pancreas. The biopsy of pancreatic mass was neuroendocrine tumour WHO grade 1. KRAS, BRAF, and MSI were negative. A multidisciplinary team discussion was done, and patient underwent laparoscopic-assisted low anterior resection, open left partial nephrectomy, and enucleation of the pancreatic mass in a single setting. The postoperative course remained uneventful. Histopathology showed rectosigmoid tumour: moderately differentiated mucinous adenocarcinoma, 3/19 lymph nodes positive for metastatic carcinoma. Renal tumour Histopathology: 28mm clear cell renal carcinoma. Pancreatic tumour histopathology: solid pseudopapillary neoplasm. All resection margins free of tumour. He received 4 cycles of adjuvant chemotherapy and now he is on surveillance. Conclusions The occurrence of synchronous triple primary malignancies presents a complex clinical challenge and requires meticulous diagnostic evaluation, multidisciplinary collaboration, and personalized treatment strategies.