SHM Converge Scientific Abstract ePoster Gallery-Renal Cell Carcinoma: A Tale of the Tongue

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This case report describes a 69-year-old man who presented with anemia, fatigue, appetite loss, and a new tongue “lump” noticed after a dental visit two months earlier. On exam, the lesion was an 8 mm firm, non-tender papule with a beefy red center and fibrinous border. Because tongue lesions can represent primary oral tumors or metastatic disease, otorhinolaryngology considered a broad differential, including neoplasm, pyogenic granuloma, atypical mucocele, and fibroma.<br /><br />Biopsy of the tongue lesion showed tumor cells positive for PAX8 and CD10 and negative for p40, S100, p63, and RCC, findings consistent with renal cell carcinoma, favoring clear cell type. Further imaging revealed a multilobulated left renal mass, pulmonary nodules concerning for metastases, bilateral adrenal lesions, and possible skull base/upper cervical spine involvement on brain MRI. The cancer was staged as IV, and the treatment goal was palliative, with nivolumab plus ipilimumab recommended.<br /><br />The report emphasizes that renal cell carcinoma is often diagnosed incidentally and classically presents with hematuria, flank pain, and a palpable mass, but can rarely present with tongue metastasis. Although RCC is the third most common tumor to metastasize to the head and neck, tongue involvement is extremely rare, and tongue metastasis as the initial presentation of RCC has been reported only a handful of times. This case highlights the importance of prompt evaluation and biopsy of new tongue lesions, especially when they are persistent or atypical, because they may represent an underlying malignancy.

Asset Subtitle

Suzanne L. Fastner

Meta Tag

Author List Matthew Aiken, Paige F. Gioia, Pinky Jha, Suzanne L. Fastner

Category Clinical Vignettes

Concept Renal Cell Carcinoma

Concept Metastatic Renal Cell Carcinoma

Concept Tongue Lesion

Concept Metastatic Malignancy

Concept Biopsy

Distinguished Non-Finalist

Presenter Organization Medical College of Wisconsin

Presenting Author Suzanne L. Fastner

Track Adult

Keywords

renal cell carcinoma

tongue metastasis

clear cell carcinoma

oral lesion

biopsy

PAX8

CD10

metastatic disease

head and neck metastasis

nivolumab ipilimumab

Renal Cell Carcinoma

Metastatic Renal Cell Carcinoma

Tongue Lesion

Metastatic Malignancy

Biopsy