spinal tumors are known to be relatively rare among neoplastic diseases . but as the expected length of life extends every year and due to the rapid development in diagnostic tools , the incidence of spinal tumors is increasing markedly . as a result , many studies on spinal tumors are under progress .
spinal tumors often do not accompany symptoms , but as it progresses , it may accompany muscle weakness , pain , or even serious disability such as quadriplegia .
therefore , like other tumors , early discovery and treatment may have an absolute impact on the prognosis of the patient2,6 ) .
generally , for spinal tumors , metastatic spinal tumor is known to be much more common than primary spinal tumor .
therefore , once a spinal tumor is identified on imaging studies such as ct scan or mri , full metastasis work up for finding a probable primary location of the tumor is essential .
especially more in case of patients with a previous cancer history ( lung cancer , breast cancer , or else ) .
it is easier to regard the spinal tumor as metastatic lesion from the existing tumors of other organs .
an abdominal ct scan was taken of a 57-year - old male patient who had sacral and right buttock and thigh pain , and revealed with a tumor - like lesion at the t12 vertebrae .
previously in 2007 , the patient had been diagnosed with colon cancer , confirmed as adenocarcinoma by open biopsy .
targeting the cancer lesion , only endoscopic mucosal resection was executed at that time and was considered as a cure . after a period of 3 years , on a follow up large intestine endoscope , a recurred lesion was identified , thus abdominal low anterior tumor resection with colostomy was performed immediately .
the patient was also diagnosed with liver cancer in 2009 , which was confirmed as hepatocellular carcinoma . about this hepatic lesion
the t12 level tumor mass was first discovered in the abdominal ct which was taken to confirm the hepatic lesion , and in the follow - up abdominal ct executed 6 months later , the diameter of tumor mass was increased from 1.5 cm to 4 cm ( fig . 1 , 2 ) .
first , it was presumed that the lesion might be a metastatic lesion originated from the primary colon or liver cancer considering the previous cancer history of the patient . as a treatment for the vertebral lesion , total laminectomy , right hemi - vertebrectomy of t12 and tumor resection was performed , and pedicle screw fixation of t10 , t11 , l1 , and l2 vertebral bodies were done
. observed intra - operatively , the tumor was found to be a brownish , hypervascular , and friable mass compressing the thecal sac on right side of t11 - 12 level , and additional erosion of the t12 lamina was also identified . on the final pathologic report , however ,
it was confirmed as plasmacytoma ( fig . 3 , 4 ) , which was completely different pathologically from previously diagnosed colon cancer or liver cancer .
on additional immunostaining , the tumor cells also showed a monoclonality for lambda immunoglobulin in its light chain .
in conclusion , the patient was finally diagnosed to have triple primary - origin tumors of adenocarcinoma , hepatocellular carcinoma , and vertebral plasmacytoma .
generally , spinal tumors are mostly metastatic tumors , and those that often cause metastasis to spine include lung cancer , breast cancer , and prostate cancer . on the contrary ,
primary spinal tumor is very rare so that among the most representative of such , multiple myeloma is found in 1 - 2 persons per 100,0001 ) , and chordoma is found in 0.5 persons per 100,0003 ) .
therefore , when a patient is found with a lesion suspicious of a tumor in the spine , the expectation is that it is a metastatic lesion and the metastatic examination and treatment are conducted , and in most cases the future biopsy results are consistent . under such circumstances , when a lesion suspicious of spinal tumor is found in a patient already diagnosed with tumors in other organs , the probability and the suspicion that this lesion is a spinal metastasis from an existing tumor are bound to be even greater . as in our case above , however , there clearly is the case where the spinal lesion is primary and a completely different type of tumor is diagnosed despite having two different types of tumors in different organs , and the treatment directions may differ completely depending on this .
for example , when a lesion suspicious of tumor is found in spine from the imaging study executed with the backache as the main symptom for a lung cancer patient , generally it is considered the spinal metastasis of the lung cancer and only palliative radiation therapy may be executed .
if the actual spinal lesion was chordoma , however , the treatment method must be completely different - it is resistant to general radiation therapy , so the treatment direction should be surgical removal and proton - beam radiation4,5 ) .
for this reason , it is emphasized that even if the discovered spinal lesion is suspicious of being a metastatic lesion , histological confirmation should be executed when possible .
triple primary - origin tumor is a very rare case across the world ; this report intended to cover the case report and also the necessity of histological confirmed diagnosis of spinal tumor .
so far , it is difficult to make a perfect differential diagnosis with imaging study alone without a biopsy for modern technology , and this may be resolved with development of imaging and interpretation technologies in the future . with this report , we wish to emphasize the necessity of pathologic confirmation and adequate further treatment even in a patient with known malignancies .
 generally , among the extradural spinal tumors , metastatic spinal tumor is much more common than primary spinal tumors . 
 thus , in the case of a spinal tumor patient with cancer history ( such as lung cancer , breast cancer , etc . ) , we used to infer that the spinal lesion is the metastasis from , primary malignancy . 
 we introduce an experience of a case of triple primary origin tumor in a 57-year - old man . 
 when the spinal lesion was found on the abdominal computed tomography scan , he already had a history of colon cancer and liver cancer . 
 initially , it was thought that the lesion would probably be a metastatic tumor from the liver or colon cancers , and the operation was performed accordingly . in the pathologic final report , 
 however , the mass was proven to plasmacytoma - the third primary lesion . 
 the patient underwent chemotherapy after surgery . 
 globally , the triple primary origin tumor has been reported very rarely . with this report 
 , we wish to emphasize the necessity of pathologic confirmation and adequate treatment even in a patient with known malignancies . 
INTRODUCTION
CASE REPORT
DISCUSSION
CONCLUSION