Multiple primary malingnant tumors are not rare recently with the development of the diagnostic methods. Billroth first documented the occurence of more than one independent cancer developing in the same patient a century ago and stated that each tumor must have an independent histologic appearences and must arise in different localities. Some studies have been reported on the possible relationship between multiple primary malignancies and excessive exposure to sunlight, occupational exposure, ionizing radiation, role of oncogenic viruses, tabacco usage, heavy alcohol consumption, and/or familial tendency, genetic factors. Many studies indicate that the prognosis of synchronous primary tumors is poorer than that of single tumor. The first case is the gastric cancer combined with chondrosarcoma of rib. Neoplasms of the ribes are rare and synchronous primary tumors are more rare. Most primary bony chest wall neoplasms are malignant, and chondrosarcoma is the most common malignant tumor in this location. The etiology of chondrosarcoma is unknown. Definitive diagnosis of chondrosarcoma can be made pathologically. The characteristic natural history of chest wall chondrosarcoma is slow growth and high local recurrence. Most tumors of the sternum require wide resection and reconstruction procedures, with potentially serious postoperative problems. The second case is the early gastric cancer combined synchronous cholangiocarcinoma that rarely associated with hepatolithiasis. It was nearly impossible to detect the malignant lesions preoperatively. And then patients with a long history of recurrent cholangitis due to hepatolithiasis should be admitted to a hospital, and precise examinations, including abdominal sonography, CT, cholangiography, aspiration cytology, choledochoscopy, frozen section biopsy pre-and intraoperatively, should be performed in order to rule out a coexisting cholangiocarcinoma especially in the operative findings of suspected malignant lesion. We experienced a 66 year-old man who was diagnosed stomach cancer with chondrosarcoma of ribs and a 63 year-old man who had early gastric cancer combined synchronous cholangiocarcinoma associated with hepatolithiasis. The patients underwent wide resection of tumor mass with Billroth-II suntotal gastrectomy. The patients had uneventful postoperative courses and discharged with adjuvant chemotheraphy.
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