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Owing to these overlapping features, diagnosis and treatment of PEAC can present a clinical challenge. We report the case of a 78-year-old man with synchronously diagnosed locally advanced pulmonary adenocarcinoma of the left lower lobe and localized right lower lobe PEAC. These malignancies exhibited distinct tumor molecular profiles and differed in their kinetic response to chemoimmunotherapy. We describe plausible mechanisms by which two distinct pulmonary malignancies are present in the contralateral lobes. To the best of our knowledge, this is the first reported case of synchronous invasive pulmonary adenocarcinoma and PEAC.<\/jats:p>","DOI":"10.1093\/omcr\/omae195","type":"journal-article","created":{"date-parts":[[2025,3,21]],"date-time":"2025-03-21T00:29:49Z","timestamp":1742516989000},"source":"Crossref","is-referenced-by-count":3,"title":["Double the trouble: pulmonary enteric adenocarcinoma with synchronous contralateral pulmonary adenocarcinoma"],"prefix":"10.1093","volume":"2025","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3248-1799","authenticated-orcid":false,"given":"Kyle","family":"Yuan","sequence":"first","affiliation":[{"name":"Internal Medicine Residency Program, San Antonio Uniformed Services Health Education Consortium , 3551 Roger Brooke Dr, JBSA Fort Sam Houston, TX 78234 ,","place":["United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Melissa M","family":"Van Dellen","sequence":"additional","affiliation":[{"name":"Department of Pathology, Brooke Army Medical Center , 3551 Roger Brooke Dr, JBSA Fort Sam Houston, TX 78234 ,","place":["United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1887-8869","authenticated-orcid":false,"given":"Joshua L","family":"Fenderson","sequence":"additional","affiliation":[{"name":"Department of Hematology\/Oncology, Brooke Army Medical Center , 3551 Roger Brooke Dr, JBSA Fort Sam Houston, TX 78234 ,","place":["United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2025,3,20]]},"reference":[{"key":"2025032016294134100_ref1","doi-asserted-by":"publisher","first-page":"3217","DOI":"10.21037\/jtd-19-4171","article-title":"Pulmonary enteric adenocarcinoma: a literature review","volume":"12","author":"Li","year":"2020","journal-title":"J Thorac 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