Diagnosis of four synchronous primary neoplasms in an adult

Abstract

Presentation of the case. A 72-year-old female patient with a one-year history of abdominal pain in the right upper quadrant, colicky, radiating to the back, accompanied by adynamia and weight loss. Abdominal distension and a painful mass on palpation in the right hypochondrium were evidenced. Imaging studies identified different lesions in the hepatic parenchyma, right adnexa, peritoneum and cecal appendix. The histopathological study described the presence of clear cell hepatocellular carcinoma, borderline mucinous tumor of low malignant potential or borderline, peritoneal pseudomyxoma and low-grade mucinous neoplasm of the cecal appendix respectively, as synchronous neoplasms. Treatment. An exploratory laparotomy was performed with excision of the adnexal lesion and the cecal appendix. The hepatic lesion received transarterial chemoembilization by interventional radiology. Follow-up with conservative management by clinical oncology was indicated. Outcome. The patient evolved with good general condition, in the follow-up with magnetic resonance imaging was classified with persistence of stable hepatic lesion. Eighteen months after the diagnosis of synchronous neoplasms, basal cell carcinoma was identified, due to the difference in the time of diagnosis this is considered a metachronous neoplasm.