Rapidly growing and ulcerating metastatic renal cell carcinoma of the lower lip: A case report and review of the literature

Abstract

Renal cell carcinomas (RCCs) have a tendency to metastasize at an early stage, therefore, the patients frequently exhibit metastatic disease at the time of diagnosis. Common locations for the metastases are adjacent organs and abdominal lymph nodes; however, occasionally metastasis to the peripheral organs may be the initial clinical symptom. The 71-year-old male patient in the current case suffered from radioresistant and aggressively behaving RCC metastasis in the mandible and lower lip, which was successfully managed by surgical resection. RCC metastasis to the facial area is considered to be uncommon based on a review of the existing literature. RCC are somewhat radioresistant and therefore, palliative surgery must be considered when treating patients with this metastatic disease.

Keywords: head and neck; lip; metastasis; renal cell carcinoma.

Figure 1

Labial and cutaneous renal cell carcinoma metastasis. (A) The patient exhibited a spontaneously bleeding mass, which had doubled in size within one week. (B) The tumor was resected with 5-mm clinical margins and transcutaneous sutures fixed to the titanium chin plate were used to support the skin and facilitate wound closure. (C) The lip was reconstructed and the skin was suspended by the titanium plate to support lip closure and prevent wound traction. (D) Postoperative follow-up at three weeks indicated no recurrent metastasis.

Figure 2

Histological analysis of the mass demonstrated renal cell carcioma metastasis. (A) Hematoxylin and eosin staining identified clear cell differentiation. Immunostaining revealed (B) some positivity for cluster of differentiation 10, in addition to (C) strong positivity for pan-cytokeratin (CK). The tumor was (D) positive for vimentin and (E) negative for CK7. (F) The Mib-1 proliferation index was high and in certain areas increased to ≤70%. Magnification, ×200.