Trifecta of Tumors: Simultaneous Detection of Three Primary Malignancies by Different Radiotracers of Nuclear Medicine

Malignancies are increasing worldwide with changing lifestyle, pollution, increasing life expectancy, and diagnostic advancements. However, multiple primary malignancies (MPMs) detected simultaneously are very rare. Here, we present a rare case of three primary malignancies (sigmoid colon, prostate, and thyroid) detected simultaneously in a 77-year-old male patient, who initially presented with bleeding per rectum and was then found to have a large pedunculated mass in the sigmoid colon on colonoscopy, which further turned out to be adenocarcinoma. On further imaging and investigations, two new separate malignancies (prostate and thyroid) were found by two different positron emission tomography radiotracers: prostate-specific membrane antigen (PSMA) and fluorodeoxyglucose (FDG). Hence, nuclear medicine modalities can play an important role in detecting MPMs using the vast array of radiotracers available now and perhaps reduce the need for multiple biopsies.