Abstract
Sarcomatoid renal cell carcinoma (sRCC) is a form of renal cancer known for its aggressiveness and poor prognosis. This report presents the case of a 65-year-old male with an unusual presentation of sRCC. The patient presented with worsening kidney function, flank pain, hematuria, fatigue, and weight loss. Imaging revealed a large, heterogeneous renal mass with evidence of invasion into surrounding structures and lymph nodes. The patient underwent a radical nephrectomy, with the removal of affected structures en bloc, followed by radiation and adjunctive chemotherapy with pembrolizumab. This report discusses challenges in diagnosing sRCC, treatment options, and emerging therapies such as checkpoint inhibitors.