Metastatic renal cell carcinoma to the oral cavity as first
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Renal cell carcinoma metastasis to the oral cavity is rare. Significantly, the oral lesion in this case was the first indication of a malignant disease in the patient. This case underscores the importance of detailed history taking, interpretation of clinical finding, and high index of suspicion for metastatic disease to the oral cavity.

A 59?year?old woman presented with the complaint of a swelling of the left buccal mucosa that was interfering with the fit of her dentures. The patient indicated that she noticed the lesion about three weeks prior to presentation. Past medical history was significant for hip and back pain, and a diagnosis of Guillain?Barre syndrome as a child. Furthermore, the patient's right kidney was removed along with a “benign” kidney mass in 2014. Intraoral examination revealed an edentulous patient with a pink?red, oval, ulcerated lesion with a white pseudomembranous surface measuring approximately 38 mm × 25 mm × 17 mm attached to the left buccal mucosa via a pedunculated stalk

At the time of surgery, the lesion had increased in size to approximately 50 mm × 30 mm× 25 mm. A complete excision of the buccal mucosa lesion was achieved, following local anesthetic infiltration, and the specimen submitted for histopathologic examination. Histologic examination of the specimen revealed an ulcerated surface mucosa, showing organoid nests of polygonal cells partitioned by fibrovascular septa and delicate capillary?sized vascular channels, imparting an alveolus?like formation in areas. Immunohistochemistry, with appropriate positive and negative controls, was positive for AE1/AE3 and renal cell carcinoma (RCC) antigen .It was determined that the patient already had disseminated disease to distant organs, including metastasis to the brain. Unfortunately, the patient died from widely disseminated disease few months later.