The occurrence of multiple primary malignancies (MPM) is not uncommon. Genetic predisposition and the development of a second primary cancer after treatment of the first with radiotherapy or chemotherapy are well documented.

Case report: A 58 years old post menopausal female was diagnosed as infiltrating ductal carcinoma breast with metastasis in axillary lymphnodes and liver. During chemotherapy she noticed bleeding per vaginum with a vaginal mass which was initially diagnosed as metastasis of ductal carcinoma and finally confirmed as Ewing’s sarcoma on immunohistochemistry and fluorescence in situ hybridization (FISH) analysis of the Ewing’s sarcoma breakpoint region 1 (EWSR1).

This case reinforces the value of histomorphology and ancillary techniques in confirming the presence of specific sarcomas at unusual sites. Although rare the possibility of MPM should be considered with the presence of malignant tumors in two or more organs. This distinction between multiple primary or metastatic cancers is important for treatment as well as prognosis.