Abstract
BackgroundRenal cell carcinoma is the third most common tumor that metastasizes to the head and neck, after breast and lung carcinomas. Tongue metastasis as an initial presentation of renal cell carcinoma is extremely rare, and very few cases have been reported. The prognosis is poor. We present a rare case of metastatic renal cell carcinoma that initially presented as a tongue lesion.Case presentationWe report the case of a 55-year-old white man who presented with a large exophytic lesion on his tongue. A biopsy was taken, and pathologic examination showed a poorly differentiated carcinoma including a sarcomatoid component. Subtotal glossectomy with neck dissection were planned, but a positron emission tomographic-computed tomography scan showed a left kidney mass. Immunohistochemical evaluation of the tongue lesion was performed, and it was compatible with metastasis from primary renal cell carcinoma. The biopsy of the renal lesion showed a high-grade unclassified renal cell carcinoma. Although our patient underwent systemic therapy, he died of hemorrhagic complications 3 months after the initiation of therapy.ConclusionTongue lesions require a complete assessment to distinguish a metastasis from a primary cancer in order to give the appropriate treatment.
Highlights
Renal cell carcinoma is the third most common tumor that metastasizes to the head and neck, after breast and lung carcinomas
Tongue lesions require a complete assessment to distinguish a metastasis from a primary cancer in order to give the appropriate treatment
Renal cell carcinoma (RCC) is the third most common tumor that metastasizes to the head and neck [2]
Summary
Lingual metastases are extremely rare, accounting for less than 1% of all malignant tongue lesions [1]. These include multitarget tyrosine kinase inhibitors (sunitinib, sorafenib, axitinib, pazopanib, cabozantinib, lenvatinib), monoclonal vascular endothelial growth factor (VEGF)-antibody (bevacizumab), mammalian target of rapamycin (mTOR) inhibitors (everolimus and temsirolimus), and immunotherapy (nivolumab). Case presentation A 55-year-old white man, who was a chronic tobacco smoker, came to our otorhinolaryngology department because of a pedunculated painful lesion on his tongue He was married and was living with his wife. A physical examination revealed a subcutaneous nodule in his right axillary region He had a performance status of 1, and arterial pressure was normal. An immunohistochemical evaluation was performed, and it was positive for Pax 8, CD10, and AE1/AE3 and negative for CK20, CK7, and thyroid transcription factor 1 (TTF1) This result is compatible with a metastasis from a primary renal cell cancer. He started second-line systemic therapy with doxorubicin and gemcitabine, but he died 10 days later because of a hemorrhagic complication of the tongue lesion
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