Compared with immunohistochemistry (PAX8 was positive in both thyroid and renal cancers), VHL combined with thyroid markers could accurately identify metastases, especially in patients of advanced age (mean age: 68 years), male (male-to-female ratio: 2:1), multiple nodules (53%), or delayed metastasis after renal cancer surgery (maximum interval 18 years). The gene discussed is VHL; the disease is renal carcinoma.