Metastatic Renal Clear Cell Carcinoma First Presenting As a Head-and-Neck Mass: two case reports

Abstract

Background: Clear cell renal cell carcinoma (ccRCC) is a prevalent malignant tumor within the urinary system, characterized by a high metastatic potential. However, instances of ccRCC metastasizing to the head and neck are exceedingly rare.
Case presentation: This article presents two patients who were admitted to the Department of Otorhinolaryngology Head and Neck Surgery. Case 1: A 61-year-old East Asian male patient presented with a painless, progressive enlargement of the left neck. Imaging revealed a 3.6 × 2.3 cm enhancing solid lesion with cystic components in the deep lobe. After surgical resection, histopathology with immunohistochemistry (CD10+, vimentin+) suggested metastatic clear cell carcinoma of renal origin. Subsequent Positron Emission Tomography-Computed Tomography (PET CT) confirmed a left renal mass (11.4 × 10.1 cm, SUVmax 5.86) with ipsilateral lung nodules, establishing the diagnosis of ccRCC with parotid and pulmonary metastases. Case 2: Another 69-year-old East Asian male patient presented to the hospital with a complaint of foreign body sensation in the pharynx. This individual had previously undergone laparoscopic left nephrectomy for left renal cell carcinoma 14 years prior. Subsequent electronic laryngoscopy identified a new growth on the right side of the pharyngeal wall, leading to laryngoscopic resection of the lesion. Postoperative pathology indicated metastatic clear cell carcinoma originating from the renal site.
Conclusion: Both cases involved metastatic lesions of ccRCC in the head and neck region, underscoring the critical importance of promptly conducting PET-CT scans and relevant pathological assessments when encountering head and neck masses with unidentified primary origins to ascertain whether they represent metastatic clear cell renal cell carcinoma(mCCRCC). The vague initial clinical manifestations of mCCRCC pose significant obstacles to its early clinical detection, necessitating multidisciplinary consultations, prolonged patient monitoring, and the administration of postoperative radiotherapy, chemotherapy, immunotherapy, and other interventions to enhance patient survival rates.