Metastatic Oncocytic Renal Neoplasm Presenting as Gastrointestinal Bleeding

Renal cancer (RC) is known for its diverse clinical presentations and unpredictable behavior. While it often metastasizes to common sites such as the lymph nodes, lungs, bones, and liver, its potential to metastasize to the gastrointestinal tract (GIT) is relatively rare. We report an unusual case of an 87-year-old male patient with a history of metastatic oncocytic renal neoplasm who presented with intermittent rectal bleeding. Colonoscopy revealed a bleeding mass in the sigmoid colon. Biopsy confirmed metastatic renal neoplasm, consistent with prior pathology. Immunohistochemistry was positive for AE1/AE3, CAIX, and PAX-8, supporting renal origin. Recent CT imaging showed enlargement of the left renal mass with direct extension into the descending colon and associated lymphadenopathy. Metastasis of RC in the GIT, especially the colon, is rare and even more so in oncocytic subtypes. This case underscores the importance of considering RC in patients with GI bleeding and a history of renal neoplasm. Early recognition and individualized, multidisciplinary management are crucial for optimal outcomes.