A rare case report of triple primary malignancies: synchronous breast ductal invasive carcinoma and lung neuroendocrine tumor, followed by chronic myeloid leukemia

Abstract

Introduction and importance: Multiple primary malignancies (MPMTs), the occurrence of two or more different primary cancers in a single person, are rare. These tumors can be synchronous or metachronous, with an incidence ranging from 0.73 % to 11.70 % in cancer patients. While invasive ductal carcinoma (IDC) is the most common form of breast cancer and lung neuroendocrine tumors (NETs) are rare, their co-occurrence as MPMT is extremely rare. In addition, chronic myeloid leukemia (CML) makes such cases even more complex.

Case presentation: We report the case of a 59-year-old woman who presented with a lump in the left breast. Diagnostic examinations confirmed breast IDC. Metastatic examination identified a separate primary, well-differentiated NET of the left lung. Both malignancies were treated surgically followed by appropriate adjuvant therapy. A year later, routine follow-up revealed an elevated white blood cell count and a subsequent bone marrow biopsy confirmed the diagnosis of CML.

Clinical discussion: The diagnosis of IDC and pulmonary NET as primary tumors is rare and the subsequent development of CML in this setting has not been reported previously. This case highlights the critical importance of thorough diagnostic evaluations to accurately differentiate between metastatic disease and MPMTs. The occurrence of three different malignancies in a single patient presents significant treatment challenges and highlights the need for personalized treatment approaches.

Conclusion: This report emphasizes the need for comprehensive diagnostic protocols in the evaluation of multiple tumors and contributes to the growing body of knowledge about MPMT. The coexistence of IDC, pulmonary NET and subsequent CML represents a rare and complex clinical scenario that requires continuous research into optimal management strategies for such cases.

Keywords: Case report; Chronic granulocytic leukemia; Colon; Invasive ductal carcinoma; Neuroendocrine tumor.

Fig. 1

A mammogram shows bilateral breast composition type A with a BI-RADS 4 assessment for the left breast and BI-RADS 1 for the right; axillary lymph nodes are unremarkable.

Fig. 2

Invasive ductal carcinoma, NOS type, infiltrative small nests and occasional tubules about 10 % (score3) with moderate enlarged nuclei(score2), scattered mitoses about 2 points in 10hpf (score 1)within desmoplastic stroma.

Fig. 3

Chest spiral CT reveals a 17 × 25 mm lobulated mass in the left lung apex with no invasion into surrounding tissues.

Fig. 4

Pulmonary typical carcinoid tumor, showing solid nests of cells with a zellballen pattern, trabecullar and pseudoglandular pattern.

Fig. 5

Bone marrow biopsy, bone particles and hypercellular marrow with absolute myeloid hyperplasia, left shifted with 2 peaks: myelocytes and segmented neutrophils, increased eosinophils and basophils. No significant granulocytic dysplasia.