Renal cell carcinoma metastases to the oral cavity: Case Rep
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Renal cell carcinoma (RCC) is the most common form of malignant renal disease, accounting for more than 90% of cases. RC has been increasingly diagnosed in the past few years due to the disease being discovered as an incidental finding in course of diagnostic investigations for other purposes. The prognosis for RCC is variable, and depends on anatomic, histologic, clinical, and molecular features of the disease, with an overall survival rate of 74% at 5 years. However, survival rate appears reduced in patients with Stage III loco-regional disease (54% at 5 years) and decreases to 8% in patients with metastatic disease.

A 71-year-old man was referred for the evaluation of an exophytic lesion of the right buccal mucosa, developed in the past two weeks and characterized by progressive enlargement. The patient’s history was negative for systemic diseases, smoking habit, and alcohol consumption.

Clinical evaluation revealed the presence of a mass of approximately 3x3 cm, with an irregular surface. The patient did not complain of the presence of symptoms associated to the lesion. The patient did not show regional lymphadenopathy. A CT was then performed to better assess the relationship of the lesion with the surrounding anatomical
structure. The lesion did not show infiltrative behavior, and the parotid gland was not involved. An incisional biopsy was performed. Histology revealed a diagnosis of clear cell carcinoma, with partial ulceration, necrotic-hemorrhagic areas, and cellular pleomorphism. Immunohistochemistry was positive for vimentin, pancytokeratin AE1/AE3, CAM 5.2, CD-10, and CK 19. the lesion was negative for cytokeratin 7
and 20, EMA, CD 117, and p40.

A thoracic and abdominal CT was performed to localize the primary tumor. The CT highlighted the presence of a large, expansive mass originating from the right kidney . The lesion presented a major axis of 17x14 cm, and infiltrated the liver parenchyma. The liver and the lungs showed multiple lesions, with aspect consistent with metastases (Fig.15-16).

Renal biopsy confirmed the nature of the primary tumor of clear cell renal carcinoma. After a multidisciplinary evaluation, the patient was prescribed with chemotherapy (Sunitinib 50 mg/d). Total removal of the oral metastatic lesion was also performed. At 6-month follow-up, the patient was
under chemotherapy. No signs of recurrence of the oral cavity metastasis were detected.

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