Case Report: Discordant pancreatic inflammatory pseudotumor in a breast cancer survivor - a diagnostic dilemma.

Background: Differentiating suspicious lesions presents a clinical challenge due to overlapping characteristics among benign, malignant, primary, and secondary pathologies, often leading to diagnostic errors and inappropriate treatment. Case presentation: We report on a 54-year-old patient with triple-negative breast cancer (TNBC) who, during postoperative surveillance, was found to have pancreatic lesions. Although initial imaging and biopsy suggested adenocarcinoma, surgical excision and subsequent histopathological examination revealed chronic pancreatitis with atypical hyperplasia. Conclusion: This case highlights the limitations of preoperative diagnostics and the complexity of distinguishing treatment-related injury from malignant recurrence, particularly in patients with prior exposure to radiotherapy and immunotherapy. To mitigate overtreatment, we advocate for a diagnostic paradigm that integrates systematic screening, advanced molecular profiling (e.g., next-generation sequencing), and a rigorous, multidisciplinary evaluation for all cancer survivors.