SHM Converge Scientific Abstract ePoster Gallery-Differential for Tonsillar Edema: Tonsillitis. Viral. None of the Above?

Pdf Summary

This case describes a 70-year-old man with a history of renal cell carcinoma (RCC), type 2 diabetes, CKD, and prior radical nephrectomy who presented repeatedly to the ED with neck pain, fatigue, hypotension, weight loss, fever, and muffled voice. Exam showed cervical lymphadenopathy and mild bilateral tonsillar edema without clear infection. Labs revealed mild lymphocytopenia, rising hypercalcemia, normal TSH, and negative viral and strep testing. CT imaging demonstrated a heterogeneous tonsillar mass that extended into and compromised the airway, requiring tracheostomy. Pathology confirmed metastatic clear cell RCC, with positive markers including CD10 and PAX8 and a high proliferative index.<br /><br />The presentation highlights that head and neck metastases from RCC are rare, and tonsillar metastasis is exceptionally uncommon, with only a handful of cases reported over the past several decades. Metastatic disease can appear long after nephrectomy, making prior RCC an important part of the differential diagnosis when patients present with unexplained tonsillar enlargement, airway symptoms, or cervical nodes.<br /><br />The authors emphasize that metastatic spread may involve hematogenous and microvesicle-mediated mechanisms, though the delayed recurrence remains incompletely explained. Treatment options depend on disease location, overall burden, and goals of care, and may include surgery, radiation, or systemic therapy. In this case, the patient was planned for outpatient stereotactic radiation therapy.<br /><br />Overall, this report underscores the need to consider metastatic RCC in patients with prior kidney cancer who develop atypical head and neck symptoms, even years after surgical treatment, and to pursue prompt imaging and tissue diagnosis when airway compromise is possible.

Asset Subtitle

Brody Bien

Meta Tag

Author List Abhijai Singh, Ali Syed, Brody Bien, Sean Rodriguez

Category Clinical Vignettes

Concept Head and Neck Metastasis

Concept Renal Cell Carcinoma

Concept Metastatic Renal Cell Carcinoma

Concept Tissue Pathology

Concept Tonsillar Edema

Distinguished Non-Finalist

Presenter Organization Froedert and the Medical College of Wisconsin

Presenting Author Brody Bien

Track Adult

Keywords

renal cell carcinoma

tonsillar metastasis

head and neck metastasis

airway compromise

cervical lymphadenopathy

tracheostomy

clear cell RCC

PAX8

CD10

stereotactic radiation therapy

Head and Neck Metastasis

Renal Cell Carcinoma

Metastatic Renal Cell Carcinoma

Tissue Pathology

Tonsillar Edema