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Review
. 2020 Dec 10;13(12):e237941.
doi: 10.1136/bcr-2020-237941.

Rare case of clear cell renal cell carcinoma presenting as a unilateral tonsil lesion

Shawn David Ellis  1 , Alison Meikle  2 , Wassim Al-Salti  3 , Georges Sinclair  4   5
Affiliations
Review

Rare case of clear cell renal cell carcinoma presenting as a unilateral tonsil lesion

Shawn David Ellis et al. BMJ Case Rep. .

Abstract

A 70-year-old man presented with gradually worsening throat discomfort. He had no prior diagnosis of cancer and no travel history of note. Examination revealed a right-sided painless neck lump. He underwent an MRI of the neck, revealing a gadolinium-enhancing tonsillar mass and two brain lesions. Biopsy of the tonsil lesion was in keeping with an epithelial neoplasm, suggesting metastatic renal cell carcinoma. This was confirmed following a staging CT, which revealed a left renal mass and lung metastases. Due to his brain metastases, the patient has been started on the tyrosine kinase inhibitor cabozantinib. A brief discussion on the diagnostic evaluation of a tonsil mass as a rare presentation of renal cell cancer follows this report.

Keywords: cancer intervention; malignant disease and immunosuppression; tyrosine kinase inhibitor; urological cancer.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Coronal image of T2-weighted MRI of the neck with red arrow pointing to gadolinium-enhancing right tonsil mass.
Figure 2
Figure 2
Histology of tonsil biopsy staining for (A, B) H&E at ×4 and ×20 magnification, (C) vimentin, (D) PAX8, (E) CD10 and (F) epithelial membrane antigen.
Figure 3
Figure 3
Axial image from CT scan with contrast with red arrow pointing to a left renal mass.
Figure 4
Figure 4
Axial images from T1-weighted MRI scan with gadolinium showing brain metastases, red arrows pointing to a small 5 mm lesion in the right front lobe, and to two enhancing nodules in the left front lobe (11 mm towards apex and 9 mm anteriorly).
See this image and copyright information in PMC

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