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

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