Renal cell carcinoma presenting as a solitary anterior superior mediastinal mass

Lesions of the anterior mediastinum typically include neoplasms of the thymus or thyroid, hemangioma, germ cell neoplasms, lymphoma and others. Renal cell carcinoma often presents with flank pain, hematuria, abdominal pain and/or fever. Chest cavity involvement by renal cell carcinoma typically manifests as pulmonary parenchymal disease with or without hilar lymph node involvement. We report an unusual presentation of renal cell carcinoma in a patient who presented with symptoms secondary to a large anterior mediastinal mass. A 64-year-old woman came to the hospital complaining of malaise, cough, dyspnea, weight loss and night sweats. Chest roentgenogram and computed tomography revealed a large anterior superior mediastinal mass without significant pulmonary parenchymal disease. She was also noted to have microscopic hematuria and a renal mass was found. Histology of both masses revealed renal cell carcinoma. This case suggests that renal cell carcinoma may merit consideration in the differential diagnosis of an anterior mediastinal mass and illustrates an unusual manner by which this lesion may present.