The authors describe an autopsy case of a 68-year-old man with four primary cancers diagnosed at autopsy including malignant meningioma, early esophageal cancer, early gastric cancer and lung cancer. Recently, the number of patients with four and five primary cancers has been increasing. According to the Annual of the Pathological Autopsy Cases in Japan, 156 cases were reported during 16 years from 1974 to 1989. In this series, cancers were detected most frequently in stomach, colon, lung, prostate, liver and esophagus. However, only two cases with four and five primary cancers including malignant meningioma were reported. Because occult cancers like prostatic cancers are unexpectedly diagnosed at autopsy, the incidence of four and five primary cancers including malignant meningioma seems to be higher when the central nervous system is examined more frequently at autopsy.