Renal cell carcinoma metastatic to the maxillary gingiva: A case report and review of the literature

Abstract

Tumor metastasis to the oral cavity is rare and is usually an indication of late-stage disease and poor prognosis. While, there are reports of renal cell carcinoma (RCC) metastatic to oral cavity, vast majority of them are to the jaw. Herein, we present a case of a 78-year-old woman with RCC metastasis limited to the oral soft tissue without any bone involvement. As the lesion solely involved maxillary gingiva, it clinically mimicked that of a pyogenic granuloma, which is a reactive, nonneoplastic condition. This case was further complicated as the patient was unaware of primary cancer and appeared to be in good physical health. Her oral metastasis marked the initial manifestation of an otherwise silent primary renal cancer.

Keywords: Maxillary gingiva; metastatic cancer; pyogenic granuloma; renal cell carcinoma.

Figure 1

(a) Clinical image showing a tan-red exophytic, lobulated mass of the maxillary anterior facial gingiva. (b) A separate, similar appearing smaller lesion was identified in the right maxillary vestibule

Figure 2

Periapical radiograph showing no changes in the quality or quantity of bone and no evidence of odontogenic infections

Figure 3

(a) Histopathologic image showing tumor cell nests completely effacing the lamina propria, (H&E, ×40). (b) These tumor nests were arranged in lobular aggregates separated by thin fibrous septae, (H&E, ×100). (c) On high power magnification, the cells displayed pink to vacuolated cytoplasm with vesicular nuclei and prominent nucleoli. Significant nuclear pleomorphism was present and the lesion demonstrated brisk mitotic activity, (H&E, ×400)

Figure 4

Histopathologic image showing strong positivity for (a) pan-cytokeratin, ×40, (b) CK8/18, ×40, (c) Pax-8, ×40, (d) CD10, ×40, (e) CA9, ×40, (f) CK19, ×40 and (g) vimentin, ×40, in the tumor cell population