Large Renal Cell Carcinoma with Multiple Metastases Presenting as Low Back Pain

Renal cell carcinoma (RCC) is a highly lethal genitourinary malignancy due to infrequent early diagnosis, which responds poorly to conventional immune therapy, chemotherapy or radiotherapy in metastatic disease. There have been great advances in the understanding of the molecular mechanisms of RCC in recent years, especially with regards to dysfunction of the Von Hippel–Lindau tumor suppressor gene in clear cell type RCC. This dysfunction has been shown to result in the activation of downstream angiogenesis related genes such as vascular endothelial growth factor. Treatment targeting this molecular pathway has been shown to improve patient prognosis and has become the standard treatment for metastatic clear cell RCC.Herein, we report a case of advanced and metastatic RCC initially presenting as low-back pain, but without the typical symptoms. Physical, laboratory and imaging examinations revealed a large left kidney tumor and multiple metastases to the liver and bones. The patient received oral tyrosine kinase inhibitor target therapy with a good tumor response.Treatment of RCC has entered the era of molecular target therapy, however some issues still need to be addressed, such as the safety issue of tyrosine kinase inhibitor and role of cytoreductive surgery. We also review related articles and have some discussion.