A rare case of syncronous solitary para-pharyngeal metastasis of clear cell carcinoma in a patient with small renal mass

Author:

Gallo Fabrizio1ORCID,Gastaldi Emilio1,Ninotta Gaetano1,Baricalla Federico2,Pastorino Alessandra3,Venturino Ezio3,Schenone Maurizio1

Affiliation:

1. Department of Urology, San Paolo Hospital, Savona, Italy

2. Department of Otorhinolaryngoiatry, San Paolo Hospital, Savona, Italy

3. Department of Pathology, San Paolo Hospital, Savona, Italy

Abstract

Introduction: Unusual metastatic sites of renal cell carcinoma (RCC) are not infrequent. We report a rare case of solitary pharyngeal metastasis as first presentation of RCC. Case description: A 74 years-old man was referred to our hospital due to rapidly progressive dyspnoea and dysphagia. Physical examination showed a large right para-pharyngeal mass. Imaging findings showed a 5.5 cm mass, suspicious for malignancy, which extended to right para and retro-pharyngeal spaces with compression of the major right cervical vessels, C2-C3 vertebral bodies osteolysis, dural sac compression and dislocation. Futhermore, a small (2.6 × 2 cm) mass located at the upper pole of the right kidney was shown. Patient underwent partial trans-oral removal of the mass. Pathological examination and immunochemistry resulting strongly suggestive for metastatic RCC. Considering the metastatic stage of the tumour and the rapidly progressive clinical worsening with poor performance status, we offered the patient a palliative treatment with tyrosine kinase and cytoreductive radiotherapy on vertebral bodies. The patient developed a rapidly progressive multifocal metastatic disease and died 4 months after the presentation. Conclusion: We think that our case is noteworthy for some aspects. Firstly, pharyngeal localizations of RCC are very rare and this is the first case of solitary pharyngeal metastasis. Secondly, this metastatic lesion was really particular because it was synchronous and twice as big than the primary tumour. Thirdly, this case is consistent with previous evidence that synchronous compared with metachronous metastasis RCC is associated with adverse effect on outcome and response to targeted treatment.

Publisher

SAGE Publications

Subject

General Medicine

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