Synchronous and metachronous of multiple primary malignancies in the same patient: A rare case report

Abstract

The synchronous and metachronous occurrence of multiple primary cancers in a single patient is an exceptionally uncommon phenomenon. However, owing to the continual advancements in diagnostic techniques, these instances are systematically classified based on the timing of their manifestation. Synchronous cases manifest within six months of the diagnosis of the preceding neoplasm, while metachronous cases emerge with an interval of more than six months between occurrences. We report the case of a 52-year-old woman who was being treated for infiltrating ductal carcinoma. The patient underwent a right mastectomy and lymph node dissection. Two months later, the patient complained of heavy menstrual bleeding, which revealed endometrial adenocarcinoma. However, a total hysterectomy with bilateral salpingo-oophorectomy was performed, along with chemotherapy. Seven months later, the patient presented with a right axillary mass. Histopathological analysis revealed to be small lymphocytic lymphoma, positive for CD5 and CD23, negative for CD3 and cyclin D1, with no evidence of breast cancer. She received chemotherapy and was treated with rituximab for 2 years. After 18 months, she developed chronic lymphocytic leukemia. She received chemotherapy with bendamustine and rituximab for 6 cycles. Currently, the last PET scan, after completing her treatment, showed no metabolic activity. The management of this condition represents an interesting clinical scenario. The choice of which tumor to treat initially and how to schedule additional treatments based on each patient's tumor risk are also essential considerations. This process must involve multidisciplinary physician team to ensure favorable outcomes.