Renal Cell Carcinoma Metastasis to Ipsilateral Parotid and Submandibular Glands: Report of a Case with Sonoelastographic Findings

Abstract

SummaryBackgroundRenal cell carcinoma (RCC) – also known as hypernephroma or grawitz tumor – accounts for 3% of the adulthood malignancies. Approximately 30–40% of the patients have metastasis at the time of the diagnosis and most common sites for metastasis are lung, regional lymph nodes, bone and liver. A total of 8–14% of the patients with RCC has head and neck metastasis. However, metastasis to major salivary glands is rarely seen. In this paper, we aimed to report a RCC case with metastasis to parotid and submandibular glands that has the same sonographic and sonoelastographic findings with the primary tumor.Case Report66-year old woman with RCC history was referred to our radiology department for neck ultrasound (US) with painful swelling in the right parotid gland region. A well-defined, 37×21 mm sized hypoechoic heterogeneous solid mass was detected in the superficial-deep lobe of the right parotid gland. The mass was prominently hypervascular in color Doppler ultrasonography scan. Coincidentally, a 13×13 mm hypoechoic lobulated solid mass was detected in the right submandibular gland with similar sonographic findings.Real-time sonoelastography (SEL) was performed to the masses and both of them were blue-green colored that indicates hard tissue. An US and SEL evaluation was also performed to the renal mass (RCC) of the patient. The primary mass was also similar in sonographic and SEL appearance as salivary gland masses. In the patient history, she revealed chemotherapy-radiotherapy treatment 1.5 years ago due to inoperable mass in the mid-lower pole of the left kidney diagnosed as clear cell RCC with vascular invasion, liver, lung and brain metastasis. Because of known primary tumor, the masses in the salivary glands were suspected to be metastatic and a tru-cut biopsy was performed. Pathological result was reported as clear cell RCC metastasis.ConclusionsThe etiology of RCC is still unknown and metastatic involvement can be seen at unexpected tissue and organs. Metastatic disease should be considered when a salivary gland mass detected in patients with RCC history. SEL examination would be helpful in differentiation of the origin of the metastatic lesion with known SEL features.

Rare case of Clear Cell Renal Cell Carcinoma metastasizing to contralateral kidney and ipsilateral parotid more than five years following nephrectomy

“…The first cases of parotid involvement due to RCC metastases were reported by Patey et al in 1965 7 . Since then, there have been limited reported cases of this phenomenon 6,[8][9][10][11][12][13][14][15][16] . In their review of the literature, Lawlor et al reported 45 cases of RCC metastasizing to the parotid, of which only 31 were complete case presentations 6 .…”

Renal clear cell carcinoma metastasis to submandibular gland: case report and review of the literature

“…RCCC is the most common primary renal tumor. It is distinguished by its remarkable metastatic potential, related to the fact that: (i) it receives 25% of the effective circulating volume and (ii) it has a great capacity to adapt to different vascular microenvironments [ 3 , 7 ]. The HN metastases of the RCCC represent ~16% of the cases [ 5 ], however, metastasis to the salivary glands are very rare.…”

“…All the cases reported were with elderly adults, with the mean age at the moment of diagnosis being 70.2 years old (r60–97). The time interval between diagnosis and the development of metastasis was variable, from months up to more than 10 years later [ 3 ]. The critical period in which the metastasis appears is from 3 to 5 years after diagnosis, nevertheless, as many as 10% of the patients develop metastasis after 5 years [ 4 ].…”

“…Renal clear cell carcinoma (RCCC) represents 2–3% of all malignant tumors and 85% of the kidney’s primary malignancies [ 1 ]. The different sites where the RCCC can produce metastasis are related to the kidney’s great vascular flow and the tumor capacity to adapt to very different vascular microenvironments [ 1 – 3 ]. The most frequent sites of metastasis are the lungs, liver, brain, skin [ 2 – 4 ], adrenal glands, bones, contralateral kidney and retroperitoneum [ 1 ].…”

Parotid gland metastasis as an initial presentation of renal cell carcinoma: A case report

“…Renal cell carcinoma (RCC) accounts for 3% of all adulthood malignancies, and for 85% of primary renal tumors ( 1 ). The incidence of RCC increases with age with a peak in the sixth decade of life; epidemiological data reveal a male predominance (2:1) ( 2 , 1 ). RCC is known for its aggressive behavior, where about one-third of patients present with metastatic disease ( 2 ).…”