Solitary metastasis of renal cell carcinoma to the third ventricular choroid plexus with rapid clinical manifestation by intratumoral hemorrhage

A 72-year-old man who had undergone nephrectomy for left renal cell carcinoma (RCC) presented with worsening of cognitive function and frequent loss of consciousness. Computed tomography (CT) revealed tumor mass in the third ventricle and hydrocephalus. A ventriculoperitoneal (VP) shunt was placed to treat the hydrocephalus. The postoperative course was uneventful, and he was followed closely without aggressive therapy. Four months after surgery, the tumor expanded rapidly due to intratumoral hemorrhage and he died due to sepsis. The autopsy findings revealed a solitary metastatic RCC in the third ventricle, with massive intratumoral hemorrhage. Solitary metastasis of RCC to the third ventricle is quite rare and difficult to treat. The case report highlights that early diagnosis and treatment are critical, even in slowly progressive RCC patients, because of the possibility of intratumoral hemorrhage.