A 50-year-old man presented to the hospital with cervical nodules evolving 3 weeks before admission. He was an active smoker with 68 pack-year tobacco intoxication. He had an history of pulmonary tuberculosis treated 20 years ago. He was admitted first in Otorhinolaryngology (ENT) Department. Initial physical examination revealed a palpable thyroid nodule in the left lobe with bilateral cervical lymph nodes. The pulmonary examination was without particularities. Serum levels of thyroid stimulating hormone (TSH) and free thyroxine were within normal limits. Neck ultrasonography showed bilateral cervical lymph nodes and a 2.8 x 2.2 cm solid hypoechoic nodule of his left thyroid lobe. The nodule presented irregular borders with extra-thyroid extension. He underwent ultrasonography-guided fine-needle aspiration cytology (FNAC) of the thyroid nodule and a cervical lymphadenopathy. The two FNAC findings matched and showed clusters of tumor cells with basophilic cytoplasm and atypical nucleated nuclei in favor of a poorly differentiated adenocarcinoma (Fig. 1). Cervical lymphadenopathy biopsy under local anesthesia was performed. Pathological examination of the lymphadenopathy showed a massively infiltrated lymph node tissue by carcinomatous proliferation. The tumor cells were polygonal with eosinophilic cytoplasm and moderately atypical nuclei. Mitosis were numerous. Immunohistochemistry (IHC) showed positive tumor cells with cytokeratin (CK) 7 but negative with TTF1 (Fig. 1). Hence, further explorations were conducted. Chest X-ray showed a lung right sided suspicious opacity with a mediastinal widening. Contrast-enhanced Computed Tomography (CT) scan of the thorax showed a 11.4 x 10 x 9.7 cm right hilar mass presenting a mediastinal extension involving carina, pericardium, and esophagus with multiple hilar and mediastinal lymph nodes (Fig. 2. C + D). Cervical CT sections confirmed the ultrasound findings (Fig. 2. A + B). The abdominal CT scan showed multiple renal, adrenal, and splenic metastasis (Fig. 2. E). Bronchial fibroscopy was not performed due to a rapid deterioration of the lung function. After discussion of this case at the multidisciplinary discussion group meeting, the diagnosis of lung adenocarcinoma stage IVB was retained. The patient was planned for chemotherapy. Unfortunately, he presented a massive hemoptysis and succumbed to his disease despite a bronchial arterial embolization.