{
  "abstract": "A woman in her 30s without prior medical history presented with 4 months 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.",
  "authors": [
    {
      "affiliations": [
        "Internal Medicine, Suratthani Hospital, Muang, Suratthani, Thailand"
      ],
      "name": "Pathomphon Phiensuparp"
    },
    {
      "affiliations": [
        "Pulmonary and Critical Care Medicine, Department of Internal Medicine, Suratthani Hospital, Muang, Suratthani, Thailand"
      ],
      "name": "Thotsaporn Morasert"
    },
    {
      "affiliations": [
        "Oncology Unit, Department of Internal Medicine, Suratthani Hospital, Muang, Suratthani, Thailand"
      ],
      "name": "Piyaporn Srikaew"
    }
  ],
  "title": "Sarcomatoid renal cell carcinoma presenting with cannonball pulmonary metastases",
  "uid": "9ed3a5c3-7a84-5878-9996-7e22df321a6e"
}