A Rare Case of Renal Cell Carcinoma Metastasis to the Coracoid Process

A 51-year-old man attended the emergency department with lower left abdominal pain and fever for three days. He recovered and was discharged home with oral antibiotics and a CT colonoscopy organised as an outpatient. This had incidentally demonstrated a solid mass in the patient's left kidney in keeping with a renal cell carcinoma (RCC). The tumour was staged as pT2N0M0 and the patient underwent an uncomplicated open left radical nephrectomy. The RCC was classified as clear cell from histology. The patient was then kept on the biannual renal surveillance protocol. Six years after the operation, the patient had reported a five-month history of pain and restricted movement in his right shoulder. MRI findings were suggestive of a metastatic lesion within the coracoid process. An ultrasound-guided biopsy concluded the lesion to be a metastatic clear cell carcinoma, which originated from the patient's RCC. A marginal resection of the lesion was performed at a tertiary centre with a good outcome. This represents a rare, reported incident of RCC metastasis to the coracoid process, an exceedingly uncommon site of spread.