THE POSSIBILITY of a patient having more than one primary malignancy should always be considered. Pickren recently disclosed results of a study of more than 2,000 autopsies and case histories in which 11% had second, third, or fourth cancers that were overlooked after diagnosis of first cancers. A review of the literature nearly 30 years ago by Warren and Gates reported an incidence of 1.84% multiple malignancies. In a very recent review of the literature Werthamer and others found an incidence of multiple malignancies varying from 0.2% to 7.8%. In his review no report was found of a patient having more than 4 separate primary malignant growths.
In the presentation of a case having quadruple primary malignancies, and in searching the literature for similar cases, Werthamer et al. decided to insist that each case conform to 6 criteria. These are as follows: (1) The malignancies must be primary in different
Hankins EA, Miller AC. Quadruple Primary Malignancies. JAMA. 1962;179(11):896–898. doi:10.1001/jama.1962.03050110064020
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