multiple primary malignancies are occurring more frequently than before and the incidence of second primary cancers varies from 1 to 16% depending on the index primary cancer . we should be aware of the pathogenesis of multiple primary malignancies as some people are more susceptible to have multiple cancers . several authors mentioned the co - occurrence of two primary cancers , namely breast cancer and thyroid cancer . we are describing a young caucasian female patient who was diagnosed with two synchronous cancers , glioblastoma multiforme ( gbm ) and papillary thyroid cancer ( ptc ) . a 19-year - old caucasian female patient without significant medical history presented to the emergency room with symptoms of dizziness , headache and emesis . family history was positive for breast cancer and lymphoma in maternal grandmother , but no reported history of thyroid malignancy . her glasgow coma scale score was 15 . on neurological examination , motor strength was five over five in all extremities . ct head [ figure 1a ] revealed acute intraparenchymal hematoma in the right cingulate gyrus and the splenium of the corpus callosum measuring 4.1  3.4 cm in size , with extension of hemorrhage into the ventricular system resulting in mild dilatation of the temporal horn of the right lateral ventricle . mri of brain [ figure 1b and 1c ] demonstrated a non - enhancing and non - hemorrhagic component of the lesion along the lateral margin of the hemorrhage that was suspicious for a tumor . subsequently , the patient developed hydrocephalus and she underwent sub - temporal craniotomy with the placement of a ventricular drain into the right temporal horn . ( a ) ct head showing intraparenchymal hematoma in the right cingulate gyrus and the splenium of the corpus callosum . ( b and c ) mri head demonstrated a non - enhancing and non - hemorrhagic component of the lesion along the lateral margin of the hemorrhage just medial to the atrium of the right lateral ventricle ct chest , abdomen , and pelvis revealed a 11 mm hypodense lesion in the left lobe of the thyroid [ figure 2a ] . ultrasonogram of thyroid [ figure 2b ] confirmed the presence of a hypoechoic nodule in the superior aspect of the left lobe of the thyroid measuring 14  11  11 mm in size . mri of brain performed four days after admission [ figure 3a ] showed a heterogenous , hemorrhagic parasagittal right parieto - occipital brain lesion of 39  31 mm with extension into the splenium of corpus . mri of brain showed further evolution of the hemorrhagic lesion on the 11 day after admission [ figure 3b ] . there were multiple areas of enhancement within the lesion with the largest area noted along the superior margin . ( a ) ct chest demonstrating a 11 mm hypodense lesion in the left lobe of thyroid . ( b ) ultrasonogram of thyroid confirmed the presence of a hypoechoic nodule in the superior aspect of the left lobe of the thyroid ( a and b ) mri of brain showed a heterogenous , hemorrhagic parasagittal right parieto - occipital brain lesion of 39  31 mm with extension into the splenium of corpus callosum . ( c ) ct head showing right parafalcine mass measuring 3.8 cm ct head [ figure 3c ] done on the same day confirmed right parafalcine mass measuring 3.8 cm , mostly isodense to adjacent brain , situated off the posterior superior aspect of splenium displacing the right lateral ventricle outward and abutting the falx . brain biopsy was performed and pathology report confirmed it as gbm [ figure 4a and b ] . tumor was positive for glial fibrillary acidic protein [ figure 4c ] , and negative for lca , pancytokeratin , and ttf-1 immunostain . ultrasound - guided fine - needle aspiration ( fna ) biopsy of the thyroid nodule was performed and specimen was sent to pathology . sections from the fna demonstrated classic papillary structures with fibrovascular cores covered by thyroid epithelium with pale chromatin , distinctly dissimilar from the brain tumor . representative histology ( gbm ) of the tumor on hematoxylin and eosin - stained sections ( a and b ) show a cellular neoplasm with moderate pleomorphism ( marked with blue arrow ) and infiltrative growth . immunochemistry is strongly positive for glial fibrillary acidic protein ( marked with an arrow ) ( c ) direct smears of the thyroid fna stained with diffquick showed numerous sheets of epithelial cells ( marked with an arrow ) , some in small papillary shaped aggregates with fine chromatin , small peripherally placed nucleoli , and nuclear grooves . sections from the fna cell block ( b and c ) demonstrated classic papillary structures with fibrovascular cores ( blue arrow ) covered by thyroid epithelium ( black arrow ) with pale chromatin , distinctly dissimilar from the brain tumor the surveillance , epidemiology , and end results ( seer ) study by hayat et al . analyzed the cancer statistics data from 1973 to 2003 on multiple primary malignancies . they found that the primary index cancer with highest second primary cancers is urinary bladder ( 16% ) , followed by oral cavity and pharynx ( 15% ) and corpus and uterus ( 11% ) . highlighted the occurrence of non - invasive cancers such as in - situ breast cancer , renal cancer , and melanoma in patients diagnosed with thyroid cancer . in u.s . surveillance , epidemiology and end - results ( seer ) cancer registry ( 1973 - 2000 ) , 2,036,597 patients diagnosed with any invasive cancer showed a 42% increased risk for second thyroid cancer when compared to the general population . patients younger than 40 years of age at the time of diagnosis of thyroid cancer had a 39% increased risk of a second cancer , whereas the risk was 6% in older patients . the author suggested etiologic similarities and possible treatment effects as culprits for the positive associations between thyroid cancer and , cancers of the brain , breast , prostate , kidney , salivary glands and leukemia . ptc is the most commonly seen thyroid malignancy , affecting young women less than 45 years age , three to four times greater than men , and 5% of them occurring in childhood and adolescents . the well - known risk factors for thyroid cancer is exposure to ionizing radiation and family history of cancer syndromes . gbm can occur in people of any age , but they are more frequent in older adults . the risk factors for gliomas development include exposure to chemical carcinogens in occupations such as rubber manufacturing , petroleum production , vinyl chloride , pesticides , forestry work and cleaning services , exposure to therapeutic ionizing radiation , and passive smoking exposure . about 5% of gliomas represents familial aggregations , with some seen in known brain tumor syndromes such as cowden 's disease , li - fraumeni syndrome and neurofibromatosis . most genetic alterations that seem to develop gbm involve intracellular signaling pathways such as receptor tyrosine kinases , ras , tgf- , tp53 , rb1 and pten . initially , our patient presented with neurological symptoms and we may consider gbm as a primary index cancer . she did not have any risk factors for thyroid cancer apart from being young woman . the papillary thyroid cancer can be considered second primary cancer as it was diagnosed co - incidentally while searching for the primary cancer for suspected brain metastasis . the author also concluded that thyroid cancer patients had a 30% increased risk of getting second primary cancer when compared to general population after analyzing the data from 13 cancer registries . similarly , canchola et al . reported that patients who had survived after thyroid cancer were more susceptible to have secondary malignancies , attributing it to their younger age and the good prognosis of the thyroid cancer . reported a case of 27 year - old japanese woman found to have five primary malignant tumors namely bilateral breast cancer , primary papillary adenocarcinoma of right lung , and ptc along with gbm within span of 5 months . chen et al . identified the aberrant expression of platelet - derived growth factor ( pdgf ) - a and pdgf receptor -  in both follicular thyroid carcinoma and ptc . when pdgf receptor -  binds to ligand , aquires a kinase activity which is associated with the multiple cancers , including astrocytomas , oligodendrogliomas , and glioblastoma . physicians should maintain high surveillance for second primary cancers at a variety of sites in patients who have been found or treated for primary cancers , especially at young age . further evaluation of genetic and environmental factors between papillary thyroid cancer and glioblastoma multiforme will improve our understanding of the etiology of these malignancies .
we are describing a 19-year - old white woman who presented with two synchronous primary cancers , namely glioblastoma multiforme and papillary thyroid cancer . 
 the patient was admitted with dizziness , headache , and vomiting . 
 ct head revealed acute intraparenchymal hematoma in the right cingulate gyrus and the splenium of the corpus callosum . 
 carotid and cerebral angiogram were unremarkable . 
 mri of the brain demonstrated a non - enhancing and non - hemorrhagic component of the lesion along the lateral margin of the hemorrhage just medial to the atrium of the right lateral ventricle that was suspicious for a tumor or metastasis . 
 brain biopsy confirmed it as glioblastoma mutiforme . 
 ct chest was done to rule out primary cancer that revealed a 11 mm hypodense lesion in the left lobe of the thyroid and ultrasound - guided fine - needle aspiration biopsy confirmed it as papillary thyroid carcinoma . 
 we should evaluate for multiple primary malignancies in young patients who are found to have primary index cancer .