Diagnostic relevance of metastatic renal cell carcinoma in the head and neck: An evaluation of 22 cases in 671 patients

Abstract

Purpose Renal cell carcinoma (RCC) is a malignant tumor that metastasizes early, and patients often present with metastatic disease at the time of diagnosis. The aim of our evaluation was to assess the diagnostic and differential diagnostic relevance of metastatic renal cell carcinoma (RCC) with particular emphasis on head and neck manifestations in a large patient series.Patients and methods We retrospectively evaluated 671 consecutive patients with RCC who were treated in our urology practice between 2000 and 2013.Results Twenty-four months after diagnosis, 200/671 (30%) of RCC had metastasized. Distant metastases were found in 172 cases, with 22 metastases (3.3%) in the head and neck. Cervical and cranial metastases were located in the lymph nodes (n=13) and in the parotid and the thyroid gland, tongue, the forehead skin, skull, and paranasal sinuses (n=9). All head and neck metastases were treated by surgical excision, with 14 patients receiving adjuvant radiotherapy and 9 patients receiving chemotherapy or targeted therapy at some point during the course of the disease. Five patients (23%) survived. The mean time of survival from diagnosis of a head and neck metastasis was 38 months, the shortest period of observation being 12 months and the longest 83 months.Discussion and conclusion Our findings show that while RCC metastases are rarely found in the neck, their proportion among distantly metastasized RCC amounts to 13%. Therefore, the neck should be included in staging investigations for RCC with distant metastases, and surgical management of neck disease considered in case of resectable metastatic disease. Similarly, in patients presenting with a neck mass with no corresponding tumor of the head and neck, a primary tumor below the clavicle should be considered and the appropriate staging investigations initiated.

Etiologic and differential diagnostic significance of tumor location in the supraclavicular fossa

“…There only was a single case in the current series . Nine of 17 cases with supraclavicular metastases of the genitourinary tract originated from a renal cell carcinoma that is well known for its unpredictable clinical behavior …”

“…Regarding the latter entities, secondary metastases were found up to 19 years after manifestation of the primary tumor (breast and renal cancer). These findings reflect the unpredictable course of disease that is known in these entities …”

“…In lung and breast cancers, the sides of primaries corresponded with the side of neck metastases. In cancers of the urogenital tract (including renal cell cancer), the incidence of metastases to the left supraclavicular fossa was significantly increased …”

“…Curative neck surgery seems to play no role in metastatic cancers of the lungs, stomach, prostate, or pancreas . Nevertheless, surgical therapy is warranted in some distant primaries, such as renal cell carcinoma, esophageal cancer, and germinal cell tumors . The importance of surgical therapy in supraclavicular metastases in breast cancer depends on the histological type …”

Gingiva Metastasis of Renal Cell Carcinoma: A Rare Case Report

“…Yüksek vaskülarite özelliğinden dolayı, uzak anatomik lokalizasyonlara metastaz olma eğilimindedir. Metastazlar en çok akciğer, kemik ve lenf nodlarına olmaktadır.Baş boyun bölgesine metastaz yaygın değildir, olguların yaklaşık % 6-18' inde görülür (1). Oral kavite metastazı ise çok daha nadirdir ve tüm oral kavite malign tümörlerinin ancak %1'ini oluşturur.…”