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Rare case of renal cell carcinoma with mandibular swelling as primary presentation
Aleena Jallu1, Manzoor Latoo, Rafiq Pampori
1Department of Otolaryngology, Head and Neck Surgery, Government Medical College, Srinagar, Jammu and Kashmir, India.
Abstract:
Introduction. Renal cell carcinoma accounts for approximately 3% of adult malignancies and 90-95% of neoplasms arising from the kidney. This disease is characterized by a lack of early warning signs, diverse clinical manifestations, and resistance to radiation and chemotherapy. Approximately one-third of patients with renal cell carcinoma have metastatic disease at initial presentation. Fifteen percent of patients with renal cell carcinoma are said to present with metastases in the head and neck region. Most of the metastases from RCC to the head and neck involve the thyroid gland. The head and neck are unusual sites for metastases, but skin, skeletal muscle, thyroid gland, nasal cavity and paranasal sinus metastases have been reported. Case Report. The following report describes a rare case where the patient presented with mandibular swelling of short duration as the primary complaint without any symptom or sign pertaining to urinary tract and was found to have renal cell carcinoma on further workup. Conclusion. Metastatic renal cell carcinoma is a diagnostic dilemma especially when there is no pointer historically towards renal cell carcinoma as was in our case. An unusual vascular osteolytic lesion in head and neck in a middle-aged person should be dealt with high index of suspicion with renal cell carcinoma at the back of the mind.
Insights
This case report highlights a rare instance of metastatic renal cell carcinoma (RCC) presenting solely as mandibular swelling. It emphasizes the diagnostic challenge of head and neck metastases from RCC without urinary symptoms.
Area of Science:
- Oncology
- Head and Neck Surgery
- Nephrology
Background:
- Renal cell carcinoma (RCC) is a significant adult malignancy, often lacking early symptoms and resistant to conventional treatments.
- Metastatic disease is common in RCC, with approximately one-third of patients presenting with metastases at diagnosis.
- The head and neck region is an unusual but reported site for RCC metastases, most commonly involving the thyroid gland.
Purpose of the Study:
- To report a rare case of metastatic renal cell carcinoma presenting as mandibular swelling.
- To underscore the diagnostic challenges posed by unusual metastatic presentations of RCC in the head and neck.
- To raise awareness among clinicians regarding the potential for occult RCC in patients with unexplained head and neck lesions.
Main Methods:
- A case report detailing a patient with a short-duration mandibular swelling as the primary complaint.
- Diagnostic workup initiated due to the unusual presentation, leading to the identification of renal cell carcinoma.
- Review of literature concerning head and neck metastases from renal cell carcinoma.
Main Results:
- The patient presented with mandibular swelling, with no initial urinary tract symptoms or signs.
- Further investigation revealed the underlying cause to be metastatic renal cell carcinoma.
- The metastatic lesion in the mandible was characterized as an unusual vascular osteolytic lesion.
Conclusions:
- Metastatic renal cell carcinoma can present as a diagnostic dilemma, particularly when initial symptoms do not point towards the urinary tract.
- Unusual vascular osteolytic lesions in the head and neck of middle-aged individuals warrant a high index of suspicion for metastatic renal cell carcinoma.
- Early recognition and consideration of RCC are crucial for timely diagnosis and management of such rare presentations.