DISCUSSION: MPMT can be “synchronous” when the second primary cancer is diagnosed within 6 months of the first, or “metachronous” when the second primary cancer is diagnosed more than 6 months after the first. Synchronous MPMT have been identified with increasing frequency probably due to more comprehensive screening protocols. Considering this patient’s significant smoking history; CT findings with a pulmonary mass; and associated cervical lymphadenopathy he had a high probability of primary lung cancer. As recommended by ACCP evidence-based clinical practice guidelines, decision was made to perform FNAC of the cervical lymph node. This is the least invasive method to confirm the diagnosis, provide staging, and guide treatment plans. FNAC result was positive for B-cell lymphoma. Patient’s clinical presentation and large lobulated pulmonary mass on CT raised suspicion for different primary pulmonary pathology. Bronchoscopy and biopsy were pursued revealing a synchronous MPMT. Anchoring to the diagnosis of B-cell lymphoma would have masked the separate primary lung malignancy.