BHD-associated renal tumors are considered to be of indolent behavior and therefore, treatment of renal tumors can be postponed until the tumor reaches a diameter of 3 cm (3 cm rule) [6,7]. Case descriptionA 53 year old women presented with acute back pain.Ultrasound examination showed a right-sided renal mass measuring 2.5 × 1.5 × 2 cm.On CT, the tumor had a maximal diameter of 2.8 cm (indicated by the arrow in Fig. 1).She was initially treated by partial nephrectomy.Histological evaluation showed a 2.8 cm eosinophilic chromophobe RCC, Fuhrmann grade 2, positive for cytokeratin 7, 8 and 18, EMA, CD10, and colloidal iron and negative for vimentin.As not all resection margins were free of tumor, a radical nephrectomy was performed subsequently.No residual tumor was detected in the remaining kidney tissue.Follow-up took place according to appropriate guidelines for RCC.At age 59, six years after removal of the primary tumor, six omental metastases were identified on abdominal CT.A biopsy showed a malignancy, histologically comparable to the previously removed primary tumor (PAX8, CK7, CD117 and CD10 positive).Since the patient had no lesions in her remaining kidney, the omental lesions were considered metastases from the primary tumor diagnosed 6 years previously.Molecular testing to get extra evidence for clonality between the primary tumor and the metastases was not possible, as no suitable material of the primary tumor was available.After diagnosis of the omental metastases, the patient was treated with immunotherapy in a phase II study (4 cycles nivolumab and iplimumab followed by 14 cycles nivolumab).The metastases show minimal progression