張顥瀚¹、錢祖明^{1 2}、李經家^{1 2}

高雄醫學大學附設醫院泌尿科部¹、高雄醫學大學臨床醫學研究所²

Hao-Han Chang¹, Tzu-Ming Chien^{1 2}, Ching-Chia Li^{1 2}

Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Taiwan¹ and Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan².

 

Introduction: It is extremely rare to discover an oral metastatic lesion, while only approximately 1 % of malignant oral lesion was metastatic. Renal clear cell carcinoma(RCCC), owning tendency to metastasize at early stage, is thought to metastasized most frequently to lung, liver, bone and adrenal gland. Cutaneous spread was thought to be rare condition. We’re reporting an unusual case of 62-year-old male patient with metastatic RCCC to lower lip.

Case report: A 62-year-old male patient was referred to our hospital due to left renal tumor noticed through abdominal echo at local medical department. At the time of presentation, we’ve already noticed a solidary tumor below his lower lip. The lesion was nontender, elastic on touch, erythematous, sizing 3 cm in diameter. Chest X-ray at admission showed focal lung lesion in the right middle lung field. For surveying the left renal tumor, abdominal computed tomography was arranged which revealed (1) Suspicious renal tumor in lower pole of left kidney, invading beyond Gerota’s fascia (2) Small lymph nodes (< 1 cm in short axis) in the hepatoduodenal ligament, gastrohepatal ligament, in the aorto-caval and para-aortic space. Chest CT was also arranged which revealed a solitary mass at right middle lobe which metastasis was considered. Tentative diagnosis was renal cell carcinoma, cT4N1M1, stage IV. We performed open radical nephrectomy, combing with right lung wedge resection and lip tumor excision in the following days. The pathology report of left kidney showed Fuhrman grade I clear cell carcinoma, pT4. Furthermore, the pathology report of lung and lower lip lesion were both consisted with the diagnosis of metastatic RCCC. The patient recovered well that he discharged at the 9^th day after the operation. We prescribed Panzopanib as 1^st line therapy of his RCCC during outpatient clinic follow up and the patient is still under regular review.

Discussion: RCC metastasized to lower lip was extremely rare while only 5 cases had been reported. These report remind u detailed physical examination has benefit of establish proper cancer staging.