Hindawi Publishing Corporation Case Reports in Urology Volume 2013, Article ID 958957, 3 pages http://dx.doi.org/10.1155/2013/958957 Case Report Unusual Presentation of Renal Cell Carcinoma: Gluteal Metastasis Yunus Emre Goger, Mehmet Mesut Piskin, Mehmet Balasar, and Mehmet Kilinc Urology Department, Meram Medical Faculty, Necmettin Erbakan University, 42080 Konya, Turkey Correspondence should be addressed to Yunus Emre Goger; dr yegoger@yahoo.com Received 18 July 2013; Accepted 4 November 2013 Academic Editors: T. J. Murtola and F. M. Solivetti Copyright © 2013 Yunus Emre Goger et al. Tis is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Renal cell carcinoma (RCC) has widespread and unpredictable metastatic potential. Te most common sites of metastatic RCC are the lungs, lymph nodes, bones, liver, and brain; however the sof tissue metastasis is rare (2,3). Here we report a 76-year-old male patient who had renal cell carcinoma presented with gluteal metastasis. To our knowledge this is the frst renal cell cancer case with gluteal metastasis at the initial diagnosis. 1. Introduction Renal cell cancer (RCC) is the most frequently seen renal malignancy. Hematuria, fank pain, and the palpable mass are the classical triad of the renal cell tumor and seen only in 6–10% of the patients. Te rest of the symptoms are mostly related to the paraneoplastic syndromes [1]. Approximately 20–30% of patients with localized tum- ours at the time of nephrectomy relapse afer surgery and develop metastasis [2]. Furthermore, 25% of patients present with metastatic RCC (mRCC) at diagnosis [3]. Although renal cell carcinoma (RCC) has widespread metastatic potential striated muscle metastasis is rare and the gluteal metastasis is the one of rarest site for the renal tumor [4]. Here we report a renal cell carcinoma with gluteal metastasis as the presenting manifestation. To our knowledge this is the frst renal cell cancer case with gluteal metastasis at the initial diagnosis. 2. Case Report A 76-year-old man presented with lef fank pain and gluteal pain causing disability to walk. On physical examination there was palpable mass on right gluteal region which was noticed by the patient within last 3 months and also edema on the right leg was observed. Complete blood count revealed anaemia (haemoglobin: 10.8 g/dL). Te renal function is almost good serum creatinine 0,6 mg/dL and blood urea nitrogen 49 mg/dL; performance status was poor. Abdominopelvic computerized tomography (CT) showed an 8 cm mass on lower pole of the lef kidney (Figure 1(a)) and solid right gluteal mass (Figure 1(b)). Tere were no signifcant lesions on the cranial radiological evaluation but thorax CT showed some nodular lesions. 99mTc bone scan revealed metastasis on right acetabulum and sacrum (Figure 2). RCC and the gluteal metastasis were verifed with renal and gluteal biopsies performed under local anesthesia (Figures 3(a) and 3(b)). Patient died within 2 weeks. 3. Discussion RCC has widespread and unpredictable metastatic potential. RCC can metastasize via venous and lymphatic routes to almost any organ; the most common metastatic sites are the lungs, lymph nodes, bones, liver, and brain [4]. In several autopsy series, about 0.4% of cases with RCC had skeletal muscle metastases [5]. However, there are few reports that show RCC metastasis to skeletal muscle in the literature [5–10]. Although the skeletal muscle has a rich blood supply, the metastases of this localization are very rare. Te reasons for the rarity can be explained hypothetically as follows: (1) high pressure of tissue due to exercise-related increased blood fow preventing implantation and growth of tumor cells; (2) prevention of tumor cell growth by lactic