Renal cell carcinoma metastasis to the maxillary bone successfully treated with surgery after vascular embolization: a case report

Abstract

Background Metastasis of renal cell carcinoma to the oral cavity is rare. Renal cell carcinoma metastases are regarded as radioresistant tumors and surgery is recommended. However, since metastatic renal cell carcinoma has poor prognosis and is composed of abundant blood vessels, it is sometimes difficult for clinicians to choose surgical therapy. Here, we report a case of a patient with renal cell carcinoma metastasis to the maxillary bone, which was successfully controlled by surgical therapy after vascular embolization, and provide a detailed literature review regarding the treatments and outcomes of renal cell carcinoma metastasis to the oral cavity. Case presentation An 89-year-old Japanese man presented with an 8 × 8-mm granulomatous tumor with palpable pulsation in the left upper gingiva, which had been clinically suspected as an arteriovenous malformation or neoplastic lesion with rich blood vessels. Our patient had undergone left nephrectomy for clear cell carcinoma 7 years prior. Pulmonary metastasis had appeared 3 years later. After intravascular embolization, our patient underwent tumor resection of the maxilla with little intraoperative blood loss. The tumor was diagnosed on histopathology as a metastasis of clear cell renal cell carcinoma to the maxillary bone. Seventeen months after surgery, he died because of pulmonary metastasis without evidence of recurrence in the oral cavity. Conclusions Our literature review reveals that oral metastatic lesions of renal cancer often exhibit rapid enlargement and cause severe symptoms, such as dysphagia and bleeding. Although oral metastasis of renal cell carcinoma has a poor prognosis due to the presence of concurrent disseminated metastases, surgical therapy may be recommended because of its high local control rate and ability to maintain quality of life. Preoperative vascular embolization is considered to be effective to reduce intraoperative hemorrhage, which leads to safe surgery.

How Can We Best Manage Patients With Oligometastatic Disease In Head And Neck Cancer?

“…However, after multivariate analysis to consider for cofounders, surgical metastasectomy remained associated with a reduced risk of death. Even in terms of locoregional control, recurrence only occurred in 16% of those treated with complete metastasectomy in this review and a local control rate of over 90% for oral cavity oligometastases of RCC origin in another review (97). Surgery is therefore advocated both for improved survival and for locoregional control.…”

“…Renal metastases have a rich blood supply, and this is of particular concern with oral cavity lesions. Involvement of interventional radiology with vascular embolisation of feeding vessels is a technique that has yielded successful results (97).…”

Comment on Marra et al. Metastatic Renal Cell Carcinoma to the Soft Tissue 27 Years after Radical Nephrectomy: A Case Report. Medicina 2023, 59, 150

“…In the case report, the authors wrote, “In November 2021, the patient underwent surgery to remove the lesion. The massive bleeding and the texture of the lesion did not allow the removal”; these difficulties with homeostasis during biopsy and the presence of bleeding at the first visit were reported by Nishii et al [ 4 ] in a large cohort of patients. RCC has a significant place among studies of angiogenesis due to its high incidence rate and dense vascularity [ 5 ]; according to these findings and the report of previous bleeding during the biopsy, we strongly believe that preoperative vascular embolization should be performed in order to prevent massive hemorrhage during biopsy and surgery for pulsatile oral metastasis of RCC, even in late-stage oncological patients.…”

Metastasis to the Oral Cavity: Report of 12 Cases

“…der Waal et al7 found 24 metastatic tumors in 1537 patients with oral cavity neoplasms. The most common primary tumors reported are, in decreasing order: breast, lung, kidney, liver, and prostate [8][9][10]. Other authors report oral metastasis from thyroid, pancreas, and gastrointestinal tract, among others 1,2,7,11.…”