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An unusual presentation of renal cell carcinoma with late metastases to the small intestine, thyroid gland, nose and skull base.

Metachronous metastatic disease may develop in up to 50% of patients with renal clear cell carcinoma (RCC) who have undergone a presumably curative radical nephrectomy. Late tumour recurrence many years after initial treatment occasionally occurs, with case reports detailing the capacity of RCC to appear almost anywhere in the body. More than one organ system is often involved in the metastatic process. Carefully selected patients may benefit from surgical resection of localized metastatic disease, particularly if they have had a prolonged, disease-free interval since primary therapy, as this may result in prolonged patient survival. Patients in early stages who have undergone treatment should be educated about possible relapse, and should be made aware of the early signs and symptoms, and the need for early intervention for possible cure should be stressed. Here we present a first case of RCC with late metachronous metastases to the small intestine, thyroid gland, nose and anterior scull base, after initial radical nephrectomy.