Management of Small Renal Masses: A Case Series of Three Metastatic Cases from the Northern Territory

Small Renal Masses (SRMs) ≤4 cm typically demonstrate limited metastatic potential and indolent growth patterns.We present three exceptional cases from Royal Darwin Hospital (2024-2025) that challenge conventional SRM risk stratification.All three SRMs presented with synchronous bone-only metastases at diagnosis, contradicting typical size-based risk predictions.Despite variable histologic features, each case demonstrated aggressive behaviour with widespread osseous involvement.The exclusive bone tropism across different histologic subtypes suggests potential common oncogenic pathways warranting investigation.These cases highlight significant exceptions to established paradigms, emphasizing that thorough staging and individualized risk assessment remain essential for all renal masses regardless of size.