Synchronous lingual and thyroid metastasis from renal cell carcinoma

Background: Renal cell carcinoma presenting with synchronous lingual and thyroid metastasis is very rare. An extensive literature search revealed only 4 cases of renal cell carcinoma presenting with lingual metastasis, have been reported. The prognosis of these patients is very poor. The treatment is palliative. We report a unique case of renal cell carcinoma presenting with lingual and thyroid metastasis and review of the literature.
Case Report: This is a 67-year-old retired nurse, presented with lingual swelling, which she noticed after accidentally biting her tongue. Wide local excisional biopsy revealed clear cell carcinoma. A CT scan of the abdomen and chest revealed a tumor in the upper pole of the right kidney. Radical right nephrectomy was performed and the histology confirmed clear cell carcinoma. A postoperative CT scan revealed multinodular goiter. An ultrasonography of thyroid gland confirmed nodularity and fine needle aspiration cytology revealed unusual epithelial neoplastic cells with papillary architecture. Total thyroidectomy was performed and the histology demonstrated multifocal metastatic renal cell carcinoma. At follow-up after two years, the patient is well and on Thyroxin. CT scan of the chest and abdomen did not reveal any evidence of recurrent or metastatic disease.
Conclusions: This unique case of Lingual and thyroid metastases from clear cell renal carcinoma, has never been reported in the literature. In contrary to the reported survival of less than 6 months in these patients, our patient is alive and well after 2 years. Our experience emphasizes the need for aggressive surgical approach of renal cell carcinoma and it’s proved metastases to improve the survival.

Keywords: lingual metastasis, Renal cell carcinoma (RCC), thyroid metastasis