# Disseminated Metastatic Renal Cell Carcinoma Manifesting With Recurrent Epistaxis: A Case Report and Comprehensive Literature Review

## TL;DR

A patient with a history of kidney cancer developed nosebleeds from a metastatic tumor, later revealing cancer spread to multiple unusual body sites after years of clear scans.

## Contribution

This case highlights the rare and delayed dissemination of renal cell carcinoma to uncommon sites, emphasizing the need for vigilance in long-term cancer monitoring.

## Key findings

- A hypervascular nasal mass was identified as metastatic renal cell carcinoma six years after a nephrectomy.
- The cancer had spread to the scrotum, back skin, gluteal muscles, and frontal bones.
- The case underscores the importance of interdisciplinary care and routine screenings for aggressive malignancies.

## Abstract

Renal cell carcinoma is an aggressive malignancy with up to 30% of patients experiencing metastases. The authors report a case of a patient status post right radical nephrectomy with 6 years of clear surveillance scans seeking evaluation of recurrent epistaxis. A friable, hypervascular mass was discovered on outpatient nasal endoscopy. The mass was surgically removed, and pathology results were consistent with metastatic renal cell carcinoma. Further workup following the operation led to the discovery of disseminated metastases of the malignancy to the scrotum, skin of the back, gluteal musculature, and frontal bones. This unique case of disseminated metastases after many years of negative routine screening demonstrates the importance of interdisciplinary care and routine screenings when managing unforgiving malignancies such as renal cell carcinoma and their insidious manners of metastasis.