Heterochronous occurrence of triple cancer of the large intestine in a patient with multiple myeloma

• Published in: Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association) Vol. 73; no. 3; pp. 638 - 642
• Main Authors: MATSUI, Shoji, SATO, Yoshiharu, MURAO, Shinichi
• Format: Journal Article
• Language: Japanese
• Published: Japan Surgical Association 2012
• Subjects: heterochronous triple colorectal cancer; hypergammaglobulinemia; multiple myeloma
• ISSN: 1345-2843; 1882-5133
• DOI: 10.3919/jjsa.73.638

A 68-year-old man who had developed general fatigue from September 2006 was pointed out having hypergammaglobulinemia by blood examination at another hospital and was referred to the department of internal medicine in our hospital in October 2006. The serum IgG level was as high as 4,420 mg/dl and monoclonal proliferation of IgG was demonstrated on urine examination. Multiple myeloma was thus diagnosed. At the same time, upper and lower gastrointestinal examinations were performed because of persisting anal bleeding. Sigmoid colon cancer was diagnosed and sigmoidectomy was performed in November of the year. After discharge melphalan + prednisolone therapy (MP therapy) was carried out. Thereafter follow-up study of the large intestine detected early cancer of the cecum. Endoscopic mucosal resection (EMR) was performed in February 2009, but tumor remnant part was suspected that required ileocecal resection in March of the year. Further early cancer of the rectum (RS) was found in April 2011 and anterior resection of the rectum was done in May 2011. Multiple myeloma can be associated with other malignant tumors in a high incidence, and, as this case suggents, such malignant tumors can be heterochronous triple cancer. Strict follow-up studies of the digestive organs would be mandatory.