Supplementary Material for: Synchronous Ampullary Adenocarcinoma and Renal Cell Carcinoma: A Rare Case Report and Literature Review

Introduction: Synchronous multiple primary malignancies (SMPMs) represent a complex oncological phenomenon with significant clinical implications. The concurrent presentation of ampullary adenocarcinoma and renal cell carcinoma (RCC) constitutes an exceptionally rare clinical entity, with minimal documented cases globally and no previous reports from Vietnam. This study examines the epistemological and therapeutic dimensions of this rare oncological convergence. Case Presentation: We present a comprehensive analysis of a 66-year-old male with synchronous ampullary adenocarcinoma and RCC. The patient presented with right upper quadrant pain, and diagnostic evaluation revealed a 14×16mm ampullary lesion and a 42×44mm right upper pole renal mass. Following multidisciplinary consultation, the patient underwent combined pancreaticoduodenectomy, right nephrectomy, and lymphadenectomy. Histopathological examination confirmed ampullary adenocarcinoma in situ and grade 2 clear cell RCC. The patient's postoperative course was uneventful, with preserved functional status at nine-month follow-up. Conclusion: The synchronous occurrence of ampullary adenocarcinoma and RCC presents substantial diagnostic and therapeutic challenges. This first documented Vietnamese case demonstrates the feasibility of curative surgical intervention despite the technical complexity involved, emphasizing the importance of integrated multidisciplinary management in optimizing outcomes for patients with rare synchronous malignancies.

引言：同步性多原发恶性肿瘤（Synchronous multiple primary malignancies, SMPMs）是一类兼具复杂性与重要临床意义的肿瘤学现象。壶腹腺癌（ampullary adenocarcinoma）与肾细胞癌（renal cell carcinoma, RCC）的同时发生属于极为罕见的临床病症，全球范围内公开报道的病例极少，且此前越南尚无相关病例报告。本研究针对这一罕见的肿瘤共发情况，从认知与治疗两个维度展开探讨。

病例报告：本研究对1例合并壶腹腺癌与肾细胞癌的66岁男性患者进行了全面分析。患者因右上腹疼痛就诊，影像学检查发现14mm×16mm的壶腹病变及42mm×44mm的右肾上级肿物。经多学科会诊后，患者接受了胰十二指肠切除术、右肾切除术联合淋巴结清扫术。术后病理组织学检查证实为壶腹原位腺癌及2级透明细胞型肾细胞癌。患者术后恢复顺利，术后9个月随访时功能状态良好。

结论：壶腹腺癌与肾细胞癌的同步发生，给临床诊断与治疗带来了极大挑战。本次为越南首例公开报道的此类病例，尽管手术操作难度较高，但证实了根治性外科干预的可行性，凸显了多学科整合管理对于改善罕见同步恶性肿瘤患者预后的重要价值。