Late Recurrence of Renal Cell Carcinoma in Unusual Sites 23 Years After Nephrectomy

Renal cell carcinoma (RCC) is a common malignancy in the elderly population and it notorious for its mechanism of late metastasis to unusual anatomical sites. Late recurrences are following curative treatment, such as radical nephrectomy. Pancreatic metastases hepatic metastatic lesions make diagnosis classification primary tumor challenging. This necessitates high index suspicion an extensive interrogation. We present case 68-year-old Hispanic female with progressive pain right upper quadrant, weight loss, decreased appetite. She has history renal treated nephrectomy radiotherapy. A pancreatic biopsy was performed based on ultrasound computed tomography findings at private clinic. Subsequently, patient referred Instituto Oncologico Nacional (ION) due immunohistochemical features suggestive well-differentiated neuroendocrine tumor. At ION, more comprehensive medical obtained, immunohistochemistry panel extended, confirming recurrence RCC. One possible explanation very relapse our presence malignant cells that were spared or seeded during surgical intervention remained dormant latent, subsequently spreading via hematogenous dissemination lymphatic system. highlight importance history, pathological examination, analysis establishing differential diagnosis, given nature RCC, which can often asymptomatically propensity recurrence. Further research should focus developing standardized surveillance protocols cases.