Renal cell carcinoma (RCC) accounts for approximately 3% of all adult malignancies and most often metastasizes to the lungs, liver, bones, and brain. Vaginal and uterine metastases are extremely rare, and presentation as a pathological fracture is also uncommon.

Case report: We present the case of a 64-year-old woman with a history of hypertension and chronic sinusitis, who was diagnosed with metastatic clear-cell RCC. Initial symptoms included painless gross hematuria. Imaging revealed a large left renal mass with renal vein tumor thrombus and suspected pancreatic invasion. She later developed right femoral shaft fracture due to bone metastasis.

Discussion: This case highlights a rare pattern of RCC metastasis involving the vagina, uterus, lungs, and femur. It emphasizes the importance of considering RCC in the differential diagnosis of atypical vaginal lesions and spontaneous fractures, especially in patients with known renal masses.

We report a rare case of advanced clear-cell RCC presenting with unusual metastatic spread. Early recognition of metastatic complications can help guide surgical and systemic treatment strategies.