Science and Education Publishing American Journal of Medical Case Reports 2374-216X 4 6 2016 7 9 Rapidly Metastasizing Sarcomatoid Renal Cell Carcinoma in a 76-year Old Male 221 223 EN Nathaniel Moulton Joe Devasahayam Univerity of Missouri, United States Rohini Kannuswamy Arul Chandran Hunter Hofmann AJMCR20164610 10.12691/ajmcr-4-6-10 2016 2 3 2016 4 23 2016 7 7 Renal Cell Carcinoma (RCC), the most lethal urological cancer has many variants. A relatively uncommon variant, sarcomatoid RCC (sRCC) is one of the most aggressive morphotypes of RCC. The complexity of this tumor is mainly due to the difficulty in its diagnosis as it can present with relatively subtle symptoms and quickly progress to very advanced stage with unusually rapid metastasis and could be fatal. We present a male patient with this rare tumor who initially presented with vague multi-system complaints. The patient rapidly deteriorated and expired following aggressive therapy and was subsequently found to have metastatic sRCC upon autopsy. We review the characteristic features of sRCC and analyze the clinical presentations, histology, prognosis as well as the atypical presentations of sRCC. This case therefore, highlights the difficulty of diagnosis prior to nephrectomy and reinforces the need for a high degree of suspicion for renal malignancies especially in the older patient.