Abstract:
Introduction and Importance: Multiple primary malignant neoplasms (MPMNs) are defined as two or more histologically distinct malignancies occurring in a single patient. Synchronous tumors are rare and present a diagnostic challenge, particularly in distinguishing metastatic disease from a second primary tumor. The coexistence of invasive ductal carcinoma (IDC) and hepatocellular carcinoma (HCC) is exceedingly uncommon.
Case Presentation: A 44-year-old Filipino female presented with a right breast mass. Imaging and core needle biopsy confirmed hormone receptor–positive, HER2-negative invasive ductal carcinoma (T1N0M0, Stage IA). Staging investigations revealed incidental hepatic lesions initially suspected to be metastatic. However, atypical imaging features and normal tumor markers prompted further evaluation. Liver biopsy with immunohistochemistry demonstrated positivity for HepPar-1 and Arginase-1 and negativity for GATA3, confirming primary hepatocellular carcinoma. The patient was diagnosed with synchronous double primary malignancies and underwent right total mastectomy with sentinel lymph node biopsy and segment VI liver resection, with an uneventful postoperative course.
Clinical Discussion: Synchronous breast and liver malignancies are rare and may be misdiagnosed as metastatic disease. Imaging alone is insufficient for definitive diagnosis. Histopathology and immunohistochemistry remain essential for accurate differentiation. Correct diagnosis is critical to guide appropriate management.
Conclusion: This case highlights the importance of tissue diagnosis in atypical presentations, enabling accurate staging and curative-intent treatment.
Keywords: Multiple Primary Neoplasms; Invasive Breast Carcinoma, Hepatocellular Carcinoma
Biography:
Dr. Jan Karl P. Mendez is a medical doctor and surgical resident currently undergoing specialized training at the Southern Philippines Medical Center (SPMC) in the Department of Surgery. A graduate of University of Cebu College of Medicine Foundation Inc., he has transitioned from his academic foundations into the rigorous clinical environment of one of the Philippines’ premier tertiary hospitals. Beyond the operating room, he is deeply committed to surgical research, focusing on advancing clinical outcomes and contributing to the evolving landscape of evidence-based surgical practices. Driven by a blend of technical precision and scientific inquiry, Dr. Mendez aims to bridge the gap between surgical intervention and innovative medical literature.
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