Acromion Process and Scapular Spine Bone Lesion as Initial Presentation of Metastatic Renal Cell Carcinoma

Renal cell carcinoma (RCC) accounts for the majority of primary renal malignancies and frequently metastasizes to the lungs, liver, brain, and bones. However, initial presentation with an acromion process scapular lesion is extremely rare. We report a 52-year-old male with progressive pain and swelling over the right shoulder for 6 months. Imaging revealed an expansile lytic lesion in the scapular spine and acromion. Histopathology and immunohistochemistry confirmed metastatic clear-cell RCC. Positron emission tomography/computed tomography identified a large left renal mass with tumor thrombus in the renal vein and inferior vena cava, pulmonary nodules, and scapular lesion. The patient was treated with systemic therapy and planned local radiotherapy. This case underscores the importance of considering metastatic carcinoma in the differential diagnosis of destructive bone lesions, even when solitary, and highlights the role of histology and advanced imaging in establishing diagnosis and guiding multidisciplinary management.