Chromophobe renal cell carcinoma with nodal involvement: A rare case report highlighting unusual molecular features

Chromophobe renal cell carcinoma (ChRCC) is a renal malignancy typically associated with indolent behavior, with nodal involvement being rare. We report a 78-year-old African American male with incidentally discovered node-positive (pN+) ChRCC with sarcomatoid differentiation who developed spinal metastases despite adjuvant pembrolizumab. Histopathologic evaluation demonstrated distinct plant-like cell membranes, while genomic profiling revealed CDK4 amplification and MTAP and CDKN2A alterations associated with aggressive tumor biology. Notably, the tumor also exhibited additional unique molecular alterations that have not been previously reported in the literature.