Multidisciplinary management of a patient with synchronous neoplasms: A case report of breast cancer plus pheochromocytoma

Abstract

Introduction: Synchronous neoplasms are a rare phenomenon. It is reported that patients with breast cancer and synchronous neoplasms most frequently develop malignant tumors in the thyroid gland (71%) or the gynecological tract (9.7%). There is no established association with pheochromocytoma, as the presence of both synchronous neoplasms is extremely rare. This case describes an atypical association of two neoplasms and their multidisciplinary approach in a public institution in Peru. Case report: Postmenopausal patient who presented with a breast tumor compatible with malignant neoplasm. Extension studies incidentally evidenced an adrenal mass with characteristics of malignancy, initially suspecting a focus of secondary metastasis. Complementary studies evidenced elevated serum and urinary metanephrines, leading to the diagnosis of pheochromocytoma. Initially, a right adrenalectomy was performed, followed later by a radical mastectomy, obtaining high-risk pathology (grade II with lymphovascular invasion, perineural invasion, and nodal macrometastases). Discussion: Synchronous neoplasms present a challenge in the diagnosis and treatment of the oncological patient. In this case, the surgical management of pheochromocytoma was prioritized due to the risk of cardiovascular complications. Delay in the management of breast pathology is a factor associated with the presence of high-risk scenarios, characterized by disease in more advanced stages, a greater probability of tumor progression, and worst oncological outcomes. Conclusions: The management of multiple neoplasms should be individualized according to the characteristics of each neoplasm and risk of complications. It is necessary to report cases of atypical associations of multiple neoplasms to broaden the diagnostic spectrum and improve the therapeutic approach for patients.