Background: Clear cell renal cell carcinoma (ccRCC) constitutes 75–80% of all renal cell carcinomas and exhibits aggressive behavior with high metastatic potential. Common metastatic sites include lungs, bones, lymph nodes, and liver, while urinary bladder involvement is exceedingly rare. Early detection of atypical metastases is critical for risk stratification, surgical planning, and systemic therapy selection. Methods: We report a 69-year-old male presenting with recurrent, painless gross hematuria and dysuria. Contrast-enhanced computed tomography revealed a left renal mass with bilateral pulmonary nodules, regional lymphadenopathy, and a bladder lesion. The patient underwent transurethral resection (TUR) of the bladder lesion, followed by robot-assisted left nephro-adrenalectomy with para-aortic lymphadenectomy. Histopathology and immunohistochemistry (PAX8+, CD10+, CAIX+, CK7−, GATA3−) confirmed ccRCC with synchronous bladder metastasis. Postoperatively, combined immune checkpoint inhibitor (ICI) therapy and tyrosine kinase inhibitors (TKIs) were initiated. Results: TUR provided symptomatic relief and diagnostic confirmation. Robot-assisted surgery enabled precise, oncologically safe excision of the primary tumor and regional metastases with minimal blood loss and no perioperative complications. Pathological staging was pT3aN1M1, ISUP grade 2, with lymphovascular invasion, confirming advanced disease requiring systemic therapy. Early initiation of ICI plus TKI therapy targeted residual micrometastases to potentially prolong survival. Conclusions: This case highlights the rare occurrence of ccRCC with synchronous bladder metastasis and underscores the importance of comprehensive imaging, detailed morphologic and immunohistochemical evaluation, and a multidisciplinary approach. Robot-assisted cytoreductive surgery combined with modern systemic therapy represents an effective strategy for advanced ccRCC, emphasizing the need for individualized treatment and long-term follow-up in atypical metastatic scenarios.

Background and Clinical Significance: Kidney transplant recipients have a 2–4-fold higher cancer risk than the general population. The sequential occurrence of multiple myeloma (MM) and native-kidney renal cell carcinoma (RCC) is rare and creates competing priorities between anti-myeloma efficacy and allograft preservation. Case Presentation: A 54-year-old woman with a 2020 living-donor kidney transplant presented in 2024 with bone pain and shoulder swelling. Low-dose whole-body CT showed multiple punched-out osteolytic lesions. Work-up revealed IgG-κ M-protein 38.5 g/L and 25% clonal plasma cells; cytogenetics showed a complex karyotype (R-ISS III). First-line bortezomib/cyclophosphamide/dexamethasone (VCd) was given while maintaining tacrolimus plus low-dose steroid. After four cycles, she achieved very good partial response (M-protein 42.3 to 5.6 g/L) with stable graft function. Follow-up imaging detected a large exophytic mass in the native right kidney; nephrectomy confirmed papillary RCC, type II. Later, the myeloma progressed with epidural extension causing cord compression. Second-line daratumumab/carfilzomib/dexamethasone (DKd) and palliative spine radiotherapy were initiated. The course was complicated by opportunistic infection and pancytopenia, and the patient died in January 2025. Conclusions: Vigilant post-transplant cancer surveillance—including native-kidney RCC—tailored immunosuppression, and multidisciplinary coordination are critical. VCd with tacrolimus may be feasible when graft preservation is prioritized; however, relapsed high-risk MM on DKd carries substantial infectious risk and a guarded prognosis.

Background: Primary renal Ewing sarcoma (ES) is an exceptionally rare and aggressive malignancy, posing significant diagnostic and therapeutic challenges in adults. Clinical presentation is often nonspecific, frequently resulting in delayed diagnosis and early metastatic dissemination. Methods: We report a case of a 45-year-old woman presenting with right lumbar pain and hematuria. Imaging included ultrasound and magnetic resonance imaging, revealing a well-demarcated multicystic lesion of the right kidney. Partial nephrectomy was performed, followed by histopathology, immunohistochemistry, and molecular analysis using fluorescence in situ hybridization to confirm ES breakpoint region 1 (EWSR1) rearrangement. Subsequent management included right nephrectomy and systemic chemotherapy following the vincristine, doxorubicin, cyclophosphamide/ifosfamide, etoposide (VDC/IE) protocol. Results: Histopathology demonstrated sheets of small round cells with Homer-Wright rosettes and strong membranous CD99 expression. Molecular testing confirmed EWSR1 rearrangement. The patient tolerated surgery and chemotherapy well, with no evidence of recurrence or metastasis at six-month follow-up. The case highlights the critical role of integrated imaging, histopathology, immunophenotyping, and molecular diagnostics in establishing the diagnosis of primary renal ES. Conclusion: Primary renal ES in adults requires a high index of suspicion, multidisciplinary evaluation, and personalized therapeutic strategies. Surgical resection combined with systemic chemotherapy can achieve disease control. Early recognition, molecular confirmation, and interdisciplinary coordination are essential to optimize outcomes in this rare malignancy.

Renal abnormalities are increasingly recognized in transfusion-dependent β-thalassemia, but evidence on intrarenal Doppler indices remains limited. This single-center case–control study compared the resistive index (RI) and pulsatility index (PI) in 44 patients aged 7–57 years and 30 apparently healthy controls aged 7–45 years. Three interlobar arterial measurements from each kidney were averaged for each participant. Group differences were evaluated using Welch’s t-test, and receiver operating characteristic analysis assessed discrimination between thalassemia and control status. Mean RI was higher in patients than controls (0.6789 ± 0.0500 versus 0.5943 ± 0.0440; mean difference, 0.0846; 95% confidence interval, 0.0626–0.1066). Mean PI was also higher (1.1655 ± 0.1824 versus 0.9197 ± 0.1290; mean difference, 0.2458; 95% confidence interval, 0.1736–0.3180). Both differences were significant (p < 0.001), with Hedges’ g values of 1.76 and 1.49, respectively. Areas under the curve were 0.895 for RI and 0.865 for PI. These findings indicate altered intrarenal hemodynamics in transfusion-dependent β-thalassemia. Without an independent kidney-injury reference standard or adjustment for potential confounders, they do not establish either index as a diagnostic marker of kidney injury.

Background: Clear cell renal cell carcinoma (ccRCC) constitutes 75–80% of all renal cell carcinomas and exhibits aggressive behavior with high metastatic potential. Common metastatic sites include lungs, bones, lymph nodes, and liver, while urinary bladder involvement is exceedingly rare. Early detection of atypical metastases is critical for risk stratification, surgical planning, and systemic therapy selection. Methods: We report a 69-year-old male presenting with recurrent, painless gross hematuria and dysuria. Contrast-enhanced computed tomography revealed a left renal mass with bilateral pulmonary nodules, regional lymphadenopathy, and a bladder lesion. The patient underwent transurethral resection (TUR) of the bladder lesion, followed by robot-assisted left nephro-adrenalectomy with para-aortic lymphadenectomy. Histopathology and immunohistochemistry (PAX8+, CD10+, CAIX+, CK7–, GATA3–) confirmed ccRCC with synchronous bladder metastasis. Postoperatively, combined immune checkpoint inhibitor (ICI) therapy and tyrosine kinase inhibitors (TKIs) were initiated. Results: TUR provided symptomatic relief and diagnostic confirmation. Robot-assisted surgery enabled precise, oncologically safe excision of the primary tumor and regional metastases with minimal blood loss and no perioperative complications. Pathological staging was pT3aN1M1, ISUP grade 2, with lymphovascular invasion, confirming advanced disease requiring systemic therapy. Early initiation of ICI plus TKI therapy targeted residual micrometastases to potentially prolong survival. Conclusions: This case highlights the rare occurrence of ccRCC with synchronous bladder metastasis and underscores the importance of comprehensive imaging, detailed morphologic and immunohistochemical evaluation, and a multidisciplinary approach. Robot-assisted cytoreductive surgery combined with modern systemic therapy represents an effective strategy for advanced ccRCC, emphasizing the need for individualized treatment and long-term follow-up in atypical metastatic scenarios.