Difficulties and missteps of diagnosis and surgical treatment of patient with multifocal metachronic carcinoma associated with primary hyperparathyroidism

We present a clinical case of a patient with metachronous primary multiple carcinoma of left kidney (2004) with left adrenal metastasis (2021), occult low-grade follicular thyroid carcinoma with lateral neck lymph node metastasis (2019), central lung cancer (2020), primary hyperparathyroidism with coherent parathyroid adenomas with intrathyroid and typical location. Patient had undergone left-side nephrectomy with bilateral adrenalectomy, double-staged thyroidectomy with parathyroidectomy and selective lateral neck dissection and right-side pulmonectomy with 4 sessions of chemotherapy. Almost 20 years after first operation patient has no signs of tumors recurrence. In addition, patient is undergoing hormone replacement therapy (HRT) of adrenal insufficiency and thyroid hormone suppression therapy. This case represents combination of non-hereditary endocrine neoplasms with multiple carcinomas. It also examples mistakes and difficulties of differential diagnosis of primary adrenal tumors and adrenal metastasis.