This is a late presentation scenario with widespread pulmonary metastatic lesions. This patient refused any biopsy and she said she "believed she doesn't have cancer". She was however referred to the oncology service. As a result there is no histological confirmation.
Renal cell carcinoma in young adults has been documented and the majority are papillary renal cell carcinoma. The differential diagnosis given the chest findings includes choriocarcinoma, breast cancer, colorectal carcinoma and uterine leiomyosarcoma.