{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,13]],"date-time":"2026-04-13T19:33:14Z","timestamp":1776108794092,"version":"3.50.1"},"reference-count":35,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2023,5,21]],"date-time":"2023-05-21T00:00:00Z","timestamp":1684627200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>The occurrence of more than one primary malignant tumor in a single patient is rare. Multiple primary malignancies can pose difficulties in differential diagnosis between primary tumors and metastasis. Here, we present a case report with multiple primary malignancies. The patient is a 45-year-old female who was diagnosed with cervical mixed squamous neuroendocrine adenocarcinoma, metastasized carcinosarcoma and extramammary vulvar Paget\u2019s disease. The patient was first diagnosed with a microinvasive squamous cervical carcinoma in situ. After a few months, the amputation of a small residual tumor and histological evaluation revealed an IA1-stage poorly differentiated (G3) mixed squamous and neuroendocrine cervical adenocarcinoma. After two years, the disease had progressed and biopsies from altered sites were taken. Histological diagnosis from an ulcerated vulvar region revealed extramammary vulvar Paget\u2019s disease. A biopsy from vagina polyp revealed an earlier diagnosed mixed squamous and neuroendocrine cervical adenocarcinoma. However, histological diagnosis from an inguinal lymph node biopsy was unexpected and revealed carcinosarcoma. It indicated either the development of another primary malignancy, or an unusual spread of metastasis. Clinical presentation as well as diagnostic and treatment challenges are discussed in this case report. This case report shows that multiple primary malignancy cases are difficult to manage both for clinicians and the patient because the therapeutic options can become limited. This complex case was managed by a multidisciplinary team.<\/jats:p>","DOI":"10.3390\/medicina59050995","type":"journal-article","created":{"date-parts":[[2023,5,22]],"date-time":"2023-05-22T03:57:32Z","timestamp":1684727852000},"page":"995","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Multiple Rare Primary Malignancies: A Mixed Squamous Neuroendocrine Adenocarcinoma of the Cervix, Metastasized Carcinosarcoma and Extramammary Vulvar Paget\u2019s Disease Case Report"],"prefix":"10.3390","volume":"59","author":[{"given":"Linas","family":"Andreika","sequence":"first","affiliation":[{"name":"Clinic of Obstetrics and Gynaecology, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, M. K. \u010ciurlionio Str. 21\/27, LT-03101 Vilnius, Lithuania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Karolina","family":"Vankevi\u010dien\u0117","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Vilnius University, M. K. \u010ciurlionio Str. 21\/27, LT-03101 Vilnius, Lithuania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marija","family":"Plioplyt\u0117","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Lithuanian University of Health Sciences, A.Mickevi\u010diaus Str. 9, LT-44307 Kaunas, Lithuania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-3602-8247","authenticated-orcid":false,"given":"Monika","family":"Bitinaityt\u0117","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Lithuanian University of Health Sciences, A.Mickevi\u010diaus Str. 9, LT-44307 Kaunas, Lithuania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vilius","family":"Rudaitis","sequence":"additional","affiliation":[{"name":"Clinic of Obstetrics and Gynaecology, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, M. K. \u010ciurlionio Str. 21\/27, LT-03101 Vilnius, Lithuania"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2023,5,21]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"79","DOI":"10.1097\/00000421-200302000-00015","article-title":"Multiple Primary Malignant Neoplasms: Case Report and a Comprehensive Review of the Literature","volume":"26","author":"Demandante","year":"2003","journal-title":"Am. J. Clin. Oncol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"3734","DOI":"10.1200\/JCO.2012.41.8681","article-title":"Second Malignant Neoplasms: Assessment and Strategies for Risk Reduction","volume":"30","author":"Wood","year":"2012","journal-title":"J. Clin. Oncol. Off. J. Am. Soc. Clin. Oncol."},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Schottenfeld, D., and Fraumeni, J.F. (2006). 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