Curative Management of Synchronous Lung and Pancreatic Adenocarcinomas in an Older Patient: A Multidisciplinary Case...

Synchronous primary malignancies are uncommon and represent diagnostic and therapeutic challenges, particularly for elderly patients with comorbidities. We report the case of a 78-year-old man with distinct primary adenocarcinomas of the lung and pancreas who was successfully treated with a curative-intent approach. Initially exhibiting unintentional weight loss, asthenia, and gastrointestinal complaints, the initial diagnostic workup, which included computed tomography (CT) and positron emission tomography/computed tomography (PET/CT), revealed a spiculated lesion in the left upper lobe and, incidentally, a hypermetabolic lesion in the pancreatic body. Due to the increased clinical suspicion and the potential for symptomatic progression, the pulmonary lesion was prioritized for further assessment investigation. Bronchial brush cytology indicated non-small cell lung adenocarcinoma, resulting in a left upper lobectomy with lymph node dissection. Histopathology confirmed a 31 mm mixed adenocarcinoma with pleural extension and mediastinal nodal involvement (stage IIIA). After adjuvant chemoradiotherapy, complicated by hematologic toxicity, further evaluation of the pancreatic lesion was conducted. A laparoscopic splenopancreatectomy revealed a 10 mm pancreatic ductal adenocarcinoma from an intraductal papillary mucinous neoplasm (stage IA). The patient underwent six cycles of adjuvant gemcitabine and capecitabine, showing no evidence of recurrence in follow-up imaging. This case features the importance of comprehensive imaging, multidisciplinary collaboration, and personalized treatment in managing synchronous malignancies, particularly considering the treatment approach for elderly patients.