Having a paraspinal arteriovenous shunt located in the paraspinal region outside the spinal canal is rare. Germline phosphatase and tensin homolog gene (PTEN) mutations have been noted in cases with a specific paraspinal arteriovenous shunt. We report a patient with a paraspinal arteriovenous shunt with multiple primary cancers and report a germline mutation diagnosed with PTEN hamartoma syndrome. PTEN hamartoma syndrome can manifest as various cancers. Early diagnosis of PTEN hamartoma syndrome is essential for improving patient prognosis and life expectancy. The coexistence of multiple primary cancers and vascular malformations can be considered red flags for PTEN hamartoma syndrome.