Quadruple primary malignancies of liver, bladder, lung and stomach in one patient

Multiple primarymalignancies are defined as two ormoremalignancies in an individual without any relationship between the tumors. Because of advances in the early detection, treatment, and supportive care for cancer, the number of cancer survivors has been gradually increasing, and this has led to an increase in the possible occurrence of subsequent malignancies. Recently, there have been reports that smoking is associated with a specific geneticmutation (the tumor suppressor gene TP53), and this genetic predisposition may be related to the development of multiple primary malignancies. Here we present a rare case of quadruple primarymalignancies of the liver, bladder, lung and stomach, some of which possibly linked to smoking-related TP53 mutation. Because of its extreme rarity and the clear relationship betweenmultiple primary malignancies and smoking-related TP53 mutation, we report this case along with a review of the relevant literature. Free full text available at www.tumorionline.it.