Background. Multiple primary lung cancers increasingly emerge in clinical practice due to improved imaging, prolonged patient survival, and growing recognition of this condition. Distinguishing multiple primary lung cancers from intrapulmonary metastases remains challenging and directly influences staging and treatment strategy. Case presentation. A 72-year-old long-term smoker was incidentally found to have a left-lung squamous cell carcinoma and additional right-lung lesions. Initial radiological and histological evaluations suggested separate primary tumors, leading to left upper lobectomy and wedge resections of two right-lung nodules. Histopathology revealed pleomorphic carcinoma in the left lung, squamous cell carcinoma in the right S9 segment, and adenocarcinoma in the S2 segment. Later reassessment classified the squamous carcinoma as a metastasis. The patient received adjuvant carboplatin–paclitaxel chemotherapy and remained recurrence-free after 4.5 years of follow-up. Conclusion. This case emphasizes the complexity of multiple primary lung cancer diagnoses and the need for a multidisciplinary approach integrating imaging, histopathology, and molecular methods. Accurate differentiation is essential for optimal management.
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