Metastatic Renal Cell Carcinoma to the Parotid Gland in the Setting of Chronic Lymphocytic Leukemia

Abstract

Renal cell carcinoma (RCC) is infamous for its unpredictable behavior and metastatic potential. We report a case of a patient with a complex history of multifocal renal cell carcinoma and chronic lymphocytic leukemia (CLL), who subsequently developed a parotid mass. Total parotidectomy revealed this mass to be an additional site of metastasis which had developed 19 years after his initial diagnosis of RCC.

Metastatic renal cell carcinoma, clear cell type, of the parotid gland

“…In addition to our case, 18 cases had reported FNAB results, including all but 2 in the past 20 years, reflecting the central role for FNAB in screening salivary gland lesions (Table ) . Of these cases, 7 were synchronous metastases, and 12 were metachronous metastases.…”

“…Of the eight cases that were not correctly reported as malignant by FNAB, four were nondiagnostic, unsatisfactory, or inconclusive; two were incorrectly diagnosed as pleomorphic adenomas (PAs); and two were thought to be negative (Table ) , . Three cases were correctly classified as malignant, but a diagnosis of metastatic RCC was not rendered: the first case showed malignant lymphoma/leukemia in a patient with a history of chronic lymphocytic leukemia (CLL); the second case was incorrectly diagnosed as primary adenocarcinoma of the parotid; and the third case was not further classified (reported as “few malignant cells”) . These results suggest at least two possible sources of diagnostic difficulty: (1) the adequacy of the FNAB specimen for diagnosis; and (2) the unbiased discrimination of metastatic RCC from other primary or metastatic lesions of the parotid (particular those with clear cell features).…”

“…RCC metastasis to the head and neck is rare, but more than 30 cases of parotid metastases have been reported over the past 50 years . Metastases account for only 1%–4% of all salivary gland tumors, with the parotid being the most common metastatic site .…”

Skull Base Clear Cell Carcinoma, Metastasis of Renal Primary Tumor: A Case Report and Literature Review

“…Given the fact that the kidneys receive 25% of the circulating blood volume, RCC has a high spreading potential via the blood [12, 13]. …”

Solitary parotid metastasis 8 years after a nephrectomy for renal cell carcinoma

“…However, imaging (CT/MRI) can help assess for possible extension or invasion, and a biopsy could potentially change management. For example, if the results were consistent with lymphoma or sialadenitis, a large resection would be unnecessary ( 9 ). Fine needle aspiration biopsy (FNAB) is commonly non-diagnostic in the previously mentioned review; out of the 13 cases mentioned in FNAB, only three were diagnostic.…”