ABSTRACT Background Besides gonadal involvement (hypogonadism, male factor infertility, and testicular hypotrophy), patients with Klinefelter syndrome (KS) may suffer from several extra‐gonadic complications, including neoplastic events. Objective The aim of this review is to summarize all major clinical evidence dealing with the association between KS and neoplastic diseases and provide practical suggestions for the management of patients with KS regarding neoplastic risk. Materials and Methods This narrative review was conducted through a comprehensive search of the PubMed database, using combinations of the following keywords: “Klinefelter syndrome,” “cancer,” “neoplasm,” “breast cancer,” “germ cell tumor,” “lymphoma,” and “testosterone replacement therapy”. Results KS is associated with a higher risk of breast cancer and mediastinal germ cell tumors and an apparent higher risk of hematological malignancies, in particular non‐Hodgkin lymphoma and leukemia. Evidence on testicular cancer is limited, with no clear increase in risk attributable to KS, while prostate cancer has a lower risk and lower mortality rate. Discussion and Conclusion Given the complexity of the syndrome and the limited available evidence, regular clinical follow‐up with targeted investigations when clinically indicated may facilitate early diagnosis and management of associated comorbidities.