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53 years male,History of hypertension and tachycardia,MRI abdomen:-Left adrenal mass:- size 5.8 cm Right renal mass:- size-3.0cm Microscopic examination of the renal mass showed vascular tumor with diffuse sheets of clear cells having Fuhrman grade II1 (Fig. 4) nuclei. There was no evidence of necrosis within the tumor. There was no evidence of extraparenchymal invasion. The differential diagnosis included RCC with contralateral adrenal metastasis, ACC with contralateral renal metastasis, synchronous RCC and ACC or synchronous RCC and adrenocortical adenoma. A panel of immunohistochemical stains was performed to sort out the diagnosis. Adrenal tumor demonstrated strong Vimentin positivity and is negative for CK7, CK20, E1/AE3, EMA, Synaptophysin and S100.Renal cell carcinoma was positive for CK7, AE1/AE3, EMA (weak) and Vimentin. It was negative for CK20, Synaptophysin and S100. The difference of immunoprofile between the two tumors documented that they originated from two different primaries. The diagnosis of synchronous tumors rather than metastasis influences the prognosis. The longest disease free interval after removal of contralateral adrenal metastasis was 12.1 years8 and the longest crude survival was 14.3 years9. In contrast non metastazing RCC has an excellent prognosis if no metastasis developed. Please visit www.oncopathology.blogspot.com