Background: Most studies have demonstrated that patients in whom renal cell carcinomas (RCC) are incidentally detected have a better prognosis than those with symptoms related to RCC. This study aimed to compare the differences in the clinico-pathological features of incidentally detected and symptomatic RCC. Methods: A retrospective study was conducted in patients who underwent surgical treatment for suspected renal masses and pathologically proven RCC. Histopathological data was retrieved from the pathology database. Incidentally diagnosed RCC and symptomatic tumors were compared. Significance was calculated using Fisher’s exact test. Results: Of the total 179 patients, 41 (22.9%) were incidentally detected and 138 (77.1%) were symptomatic. Incidentally detected tumors were smaller, on average being 3.63 cm, and diagnosed at earlier stage and lower grade when compared to symptomatic tumors. More aggressive histology, such as sarcomatoid variants, collecting duct tumors and high grade tumors were more often seen in the symptomatic group. Conclusions: Incidentally detected RCC has significantly better pathological prognostic factors than the symptomatic group. Symptomatic tumors present at a significantly higher stage, grade and are more aggressive than incidental lesions, particularly at later stages. [Arch Clin Exp Surg 2017; 6(1.000): 28-32]