As a result of development in medical diagnostic technology, the incidence of double primary cancer is increasing. In case that one primary cancer was identified by pathologic finding and has suggestive multiple metastatic lesions of the cancer, it is often difficult that the lesions are considered as another synchronous primary malignancy, not as metastasis of primary cancer. Here, we report a rare case of synchronous double primary renal cell carcinoma that was diagnosed initially as metastatic duodenal adenocarcinoma. A 66-year-old man presented with a palpable abdominal mass. Abdominal computed tomography showed duodenal wall thickening and hypervascular masses in the liver and left kidney. Esophagogastroduodenoscopy revealed an ulcerative lesion in the duodenal bulb, and endoscopic biopsy identified moderately-differentiated adenocarcinoma. We regarded the findings as duodenal adenocarcinoma with metastasis to liver and kidney. So he was treated with fluoropyrimidine-based chemotherapy for the diagnosis of duodenal adenocarcinoma with liver and renal metastases. After 10 months, he developed a right forearm mass. Morphological and immunohistochemical analysis of an incisional biopsy of the forearm mass were consistent with a diagnosis of metastatic renal cell carcinoma. Even when there is a pathologically confirmed malignancy, clinicians must consider the possibility of synchronous double primary malignancy in metastatic lesions.

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• Jiyoul Yang(Department of Internal Medicine, Chungbuk National University Hospital, Cheongju 28644, Korea)
• Ho-chang Lee(Department of Pathology, College of Medicine, Chungbuk National University, Cheongju 28644, Korea)
• Ok-Jun Lee(Department of Pathology, College of Medicine, Chungbuk National University, Cheongju 28644, Korea)
• Daehwan Bae(Department of Internal Medicine, Chungbuk National University Hospital, Cheongju 28644, Korea)
• Seungjun Jeong(Department of Internal Medicine, Chungbuk National University Hospital, Cheongju 28644, Korea)
• Moon Ki Choi(Department of Internal Medicine, Chungbuk National University Hospital, Cheongju 28644, Korea)
• Jihyun Kwon(Department of Internal Medicine, Chungbuk National University Hospital, Cheongju 28644, Korea)
• Hye Sook Han(Department of Internal Medicine, College of Medicine, Chungbuk National University, Cheongju 28644, Korea) Corresponding author