The January issue of The Journal of Thoracic and Cardiovascular Surgery recently published an article which demonstrates the high discrepancy of genetic features in patients with multiple pulmonary tumors. The article titled “ Favorable prognosis and high discrepancy of genetic features in surgical patients with multiple primary lung cancers” by Chen et al . (1) is another valuable retrospective study evaluating patients treated for multiple primary cancers. In addition to survivorship data, the group reviewed driver mutations within the multiple tumors showing highly discordant mutations arguing that the lesions represent separate primary tumors of the lung as opposed to metastatic tumors. This article brings to the forefront issues frequently seen in patients with multiple pulmonary lung cancers.