A 56-year-old female was admitted, in November 2011, to our department with a complaint of masse in her left neck region gradually evolved since 7 months with palpitations. The patient is asthmatic treated by Salbutamol, is hypertense with no treatment followed since 2009, and is treated for pulmonary tuberculosis 33 years ago. The past medical history of the patient included a left nephrectomy without therapeutic supplement in 2006 for renal tumoral syndrome revealed by left chronic lumbar pains. The pathological analysis revealed chromophobe renal cell carcinoma, T2N0Mx stage II, Fuhrman nuclear grade 2, and no sarcomatoid or papillary or tumor necrosis components were identified. A physical examination of the patient showed a painless left cervical masse; its greatest diameter is 04 cm with hard consistency. The thyroid function tests were normal. The thyroid ultrasonographic examination showed multinodular goiter with hypoechoic left nodule whose lower limit was flooded at the level of the Superior thoracic aperture. The ultrasonographic examination of the neck detected two contiguous left juguloomohyoid lymphadenopathies having a metastatic appearance. The CT scan of the neck showed a diving left thyroid nodule with left lateral jugular lymph nodes probably metastatic (Figures 1 and 2). An FNA biopsy from neck lymph node had not been made.
A total thyroidectomy was performed (extempore histopathological examination showed vesicular adenoma) with left functional posterolateral neck dissection (II, III, IV, and V levels) with anterior (or central) compartment neck dissection (VI) which found at left VIb a voluminous lymphadenopathy adherent to the left thyroid lobe lending confusion to a thyroid nodule. The pathological examination of the dissected lymphadenopathies in left VIb found the appearance of metastatic chromophobe renal cell carcinoma confirmed by immunohistochemical study. The pathological slides of the primary tumor were reviewed, and it was found that both the primary tumor and the neck metastases had the same origin.
An abdominal ultrasonographic examination showed a nephrectomy scar, on the left side and found retroperitoneal lymph nodes. The scintigraphic bone scan imaging was negative for metastatic lesions. The thoracoabdominopelvic scan also confirmed ultrasonographic findings and detected 3 voluminous retroperitoneal lymph nodes probably metastatic (Figure 3). 
Based on the above features, a decision was made consisting for no surgical treatment on the retroperitoneal nodes. The patient was started on antiangiogenic therapy post-operatively (sunitinib). After the sixth month of the operation and the second month of the first cure of sunitinib, she had no evidence of the recurrence of the neck region and another thoracoabdomino-pelvic CT scan confirmed that the retroperitoneal lymph nodes kept the same number and measures.