Chang Woo Lee, Shadi Basyuni, Michal Barabas, Vijay Santhanam
Renal cell carcinoma (RCC) presents non-specifically with the classic triadic presentation only occurring in 10-15% of cases. Up to a third of patients with RCC have distant metastasis on presentation with common sites being lungs, liver, bones and the brain. We describe a rare case of metastatic RCC whose only clinical manifestation was a right-sided mandibular swelling.
All information was extracted retrospectively from the patient's notes, imaging and pathology results.
A 56-year-old female was referred to Maxillofacial Surgery by her dentist with a 3-month history of right-sided facial swelling. This had been slowly increasing in size and was associated with intermittent paraesthesia to the lower lip and tongue. Her general practitioner had previously prescribed a course of antibiotics that had not improved the facial swelling. Imaging of the mandible revealed a lesion that had caused complete destruction of the right condyle, coronoid and ramus. Ultrasound-guided biopsy revealed the mass to be metastatic RCC. Subsequent computed tomography imaging of the abdomen and pelvis confirmed the presence of a primary in the right kidney. Additional history taking by the oncologist later revealed a single episode of gross haematuria 7 months prior to her facial swelling, which resolved with a course of antibiotics. Due to the advanced nature of the disease, radical treatment was not suitable and chemotherapy was initiated with palliative intent. Despite an initial positive response to therapy, the disease progressed and the patient passed away 11 months after the initial diagnosis.
Chronic unilateral parotid swellings require further investigation. Malignancies should be excluded in any facial swellings causing cranial nerve palsies. Orofacial symptoms can be the initial presentation of systemic disease. Exclude malignancy in gross haematuria presenting in adults.