ABSTRACT
Renal cancer with multiple differentiation and multiple components is rare in clinic. It has the character of high malignancy, early metastasis, and poor prognosis. A patient with multiple differentiated renal cell carcinoma was diagnosed in our hospital mainly because of emaciation, fatigue and loss of appetite. CT scan showed the 6.5 cm×6.0 cm mass in the lower pole of right kidney with unequal enhancement and necrosis. The chest CT scan showed multiple enlarged lymph nodes in the mediastinum and right superior clavicle. The patient accepted the laparoscopic retroperitoneal right nephrectomy and right supraclavicular lymph node biopsy. Postoperative pathology showed multiple differentiated renal cell carcinoma with localized sarcomatoid leisions, including clear cell carcinoma, collecting duct-like carcinoma and medullary carcinoma combined with right supraclavicular lymph node metastasis. Targeted therapy was performed at 1 month after surgery. Liver and lung metastasis occured at 6 months and the patient died of multi-organ failure at 12 months after surgery.