{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,17]],"date-time":"2026-01-17T06:35:23Z","timestamp":1768631723597,"version":"3.49.0"},"reference-count":11,"publisher":"BMJ","issue":"1","funder":[{"name":"Department of medicine, Suratthani Hospital"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2026,1,7]]},"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:p>A woman in her 30s without prior medical history presented with 4\u2009months of progressive back pain that evolved to paraplegia, followed by dyspnoea and haemoptysis. Imaging revealed numerous, well-circumscribed pulmonary nodules consistent with cannonball metastases, a loculated right pleural effusion, bilateral renal masses, pancreatic nodules and osteolytic L5 collapse with cord compression. The lung lesion biopsy demonstrated a poorly differentiated neoplasm, which on immunohistochemistry was most consistent with metastatic sarcomatoid carcinoma of renal origin. She required intubation, pleural drainage and high-dose dexamethasone, achieving partial neurological recovery, and subsequently received palliative spinal radiotherapy. Sarcomatoid renal cell carcinoma is a rare, aggressive variant with rapid progression and poor prognosis. Immune checkpoint inhibitors, alone or combined with vascular endothelial growth factor-targeted agents, are current standard therapy, but access may be restricted in resource-limited settings. Although the cannonball pattern can suggest renal or other hypervascular primaries, a comprehensive imaging and histological evaluation remains essential for diagnosis.<\/jats:p>","DOI":"10.1136\/bcr-2025-270026","type":"journal-article","created":{"date-parts":[[2026,1,16]],"date-time":"2026-01-16T19:00:34Z","timestamp":1768590034000},"page":"e270026","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Sarcomatoid renal cell carcinoma presenting with cannonball pulmonary metastases"],"prefix":"10.1136","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-0601-5473","authenticated-orcid":false,"given":"Pathomphon","family":"Phiensuparp","sequence":"first","affiliation":[{"name":"Internal Medicine, Suratthani Hospital, Muang, Suratthani, Thailand"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3353-2033","authenticated-orcid":false,"given":"Thotsaporn","family":"Morasert","sequence":"additional","affiliation":[{"name":"Pulmonary and Critical Care Medicine, Department of Internal Medicine, Suratthani Hospital, Muang, Suratthani, Thailand"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Piyaporn","family":"Srikaew","sequence":"additional","affiliation":[{"name":"Oncology Unit, Department of Internal Medicine, Suratthani Hospital, Muang, Suratthani, Thailand"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2026,1,16]]},"reference":[{"key":"2026011611001717000_19.1.e270026.1","doi-asserted-by":"publisher","DOI":"10.1148\/rg.336125110"},{"key":"2026011611001717000_19.1.e270026.2","doi-asserted-by":"crossref","unstructured":"Ternes TH . Pulmonary metastases. In: Rosado de Christenson ML , Bhalla S , Abbott GF , et al , eds. Chest imaging. 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