Suzuki A, Toyooka S, Ozaki K, Kawase M, Takahashi T
Rinsho Ketsueki. 1989 Apr;30(4):553-7.
A 71-year-old female was admitted to the Fukui Red Cross Hospital because of abnormal genital bleeding in Feb., 1987. She underwent gastrectomy for early gastric cancer (IIc) 5 years earlier, mastectomy for early breast cancer (stage I) 3 years earlier and radiation therapy (60Co 350rad x 25 days) and chemotherapy (5FU, 200 mg/day, orally) for uterine cancer (stage IIb) 2.5 years earlier. These 3 cancers had quite different histological features one from the other. Laboratory investigation revealed leukocytosis (216, 100/microliters) with 90% blasts. The bone marrow was hyperplastic with 87% blasts. Although 90% of blasts had myeloperoxidase activity, surface marker analysis of the blasts revealed T-cell (CD2, CD3) phenotypes suggesting that the disease was so-called hybrid acute leukemia. She died of intracranial hemorrhage on the 2nd hospital day. An autopsy showed generalized leukemic infiltration and residual uterine cancer without metastasis to other sites. In our country, quadruplicate malignancies including hematological malignancy have been rarely described. The possible pathogenesis of multiple cancers has been discussed.
一名71岁女性因1987年2月生殖器异常出血入住福井红十字医院。她5年前因早期胃癌（IIc期）接受了胃切除术，3年前因早期乳腺癌（I期）接受了乳房切除术，2.5年前因子宫癌（IIb期）接受了放射治疗（60钴350拉德×25天）和化疗（5-氟尿嘧啶，200毫克/天，口服）。这三种癌症的组织学特征彼此差异很大。实验室检查显示白细胞增多（216,100/微升），原始细胞占90%。骨髓增生，原始细胞占87%。虽然90%的原始细胞具有髓过氧化物酶活性，但对原始细胞的表面标志物分析显示为T细胞（CD2、CD3）表型，提示该疾病为所谓的混合性急性白血病。她在住院第二天死于颅内出血。尸检显示全身白血病浸润，残留子宫癌，无其他部位转移。在我国，包括血液系统恶性肿瘤在内的四重恶性肿瘤很少有报道。本文讨论了多种癌症可能的发病机制。
