Raising awareness of acute onset of swelling and lip paraesthesia in a teenage patient

Abstract

We report a case of papillary renal cell carcinoma in a 19-year-old patient that manifested as ipsilateral numbness of the lower lip and swelling in the region of masseter insertion. Despite there being widespread metastatic disease at presentation, the diagnosis was delayed with false reassurance from a normal brain scan and the assumption that the symptoms were due to infection related to the lower wisdom tooth. Once the primary tumour site was established, the patient responded to the relatively new immunotherapy treatments for advanced renal cell carcinoma as advocated in the 2019 NICE guidance. There are no other documented case reports that discuss papillary renal carcinoma with metastatic spread to the mandible in teenagers. CPD/Clinical Relevance: This case highlights the importance of malignancy being a differential diagnosis of lip paraesthesia irrespective of age.