Indian Journal of Urology
CASE REPORT
Year
: 2005  |  Volume : 21  |  Issue : 2  |  Page : 120--121

Carcinoma of tongue with solitary metastasis to kidney - case report


YB Thyavihally1, HB Tongaonkar1, AK D'Cruz2, RF Chinoy3,  
1 Departments of Urologic Oncology,Tata Memorial Hospital, Mumbai, India
2 Head and neck Oncology,Tata Memorial Hospital, Mumbai, India
3 Pathology, Tata Memorial Hospital, Mumbai, India

Correspondence Address:
Y B Thyavihally
Room No. 52, Main Building,Tata Memorial Hospital, Parel,Mumbai - 400012
India

Abstract

The most common tumors which metastatise to kidney are lymphoma, leukemia, and lungs. Metastatic tumors of the kidney are usually small, asymptomatic and occasionally cause flank pain and hematuria. Distinction from renal cell carcinoma is difficult to differentiate and a tissue diagnosis is imperative. Solitary metastasis to kidney from carcinoma tongue is rare. We report a case of isolated renal metastases from tongue cancer to show at the possibility of tumor metastasis, although rare, should always be considered in the differential diagnosis of renal mass.



How to cite this article:
Thyavihally Y B, Tongaonkar H B, D'Cruz A K, Chinoy R F. Carcinoma of tongue with solitary metastasis to kidney - case report.Indian J Urol 2005;21:120-121


How to cite this URL:
Thyavihally Y B, Tongaonkar H B, D'Cruz A K, Chinoy R F. Carcinoma of tongue with solitary metastasis to kidney - case report. Indian J Urol [serial online] 2005 [cited 2019 Dec 14 ];21:120-121
Available from: http://www.indianjurol.com/text.asp?2005/21/2/120/19636


Full Text

The metastatic tumors are the most common malignancies of the kidney. The most common tumors, which metastasize to kidney, are lymphoma, leukemia, lungs, gastrointestinal tract, etc. Isolated metastasis from carcinoma of tongue metastasizing to the kidney is rare. We report a case of carcinoma of the tongue relapsed as isolated lesion in the kidney.

 Case report



The patient was a 55-year-old female, known case of squamous cell carcinoma of the tongue diagnosed at the age of 34 years for which wide excision of the lesion was done. Ten months later, patient underwent radical neck dissection for left neck nodes. She was disease free for 20 years when she developed local recurrent lesion. Laser excision of the lesion was done. The histopathology report was high-grade keratinizing squamous cell carcinoma deeply invading the muscle. Postoperative radiotherapy was given to tongue and bilateral neck with cobalt 60.

About 4 months later patient presented with mild hematuria. Physical examination, urine cytology, cystoscopy, and renal parameters were normal. Computerized tomography (CT) scans of the abdomen revealed an ill-defined heterogeneously enhancing, endophytic lesion involving mid, and lower pole of the right kidney with per renal stranding [Figure 1]. Right retrograde pyelogram (RGP) was suggestive of space occupying lesion lower pole of the kidney and right ureteric washing for cytology was negative. The metastatic work up was normal. In view of these findings the differential diagnosis of renal cell carcinoma, transitional cell carcinoma or metastatic tumor from known primary from the tongue were considered. Fine needle aspiration and biopsy was inconclusive. Since it was difficult to rule out renal cell carcinoma, right radical nephrectomy with 3 x 2 cm2 lymph nodal mass excision was done. On gross examination the kidney was 13 x 7 x 6 cm3 with grayish white tumor of 11 x 6 x 4 cm3, breaching capsule, and infiltrating the gerotas fascia [Figure 2]. The histopathology report was moderately differentiated keratinizing squamous cell carcinoma of kidney with normal pelvicalyceal system suggestive of renal metastasis from known primary in the tongue [Figure 3]. Patient received cisplatin and ifosfamide based chemotherapy but died of severe neutropenic septicemia.

 Discussion



Carcinoma of tongue is a common cancer of the oral cavity. A search of published literature in pubmed 1950-2004 revealed that this is the first reported case of isolated metastasis to kidney from carcinoma tongue. Metastatic tumors of the kidney are usually small, asymptomatic, and occasionally cause flank pain and hematuria. They are usually of hematogenous spread, multifocal, bilateral, and associated with widespread nonrenal metastases.[1] Lung cancer is most common solid malignancy to metastatise to the kidney.[2] Computerized tomography scan is presently the most sensitive modality to detect and evaluate renal metastases.[3] Distinction from renal cell carcinoma is difficult to differentiate and a tissue diagnosis is imperative.

Most patients are managed with systemic therapy. Nephrectomy is rarely required in situations like uncontrollable renal hemorrhage or difficult in diagnosis. Our case was of interest because of its solitary nature, difficult in differentiating from primary renal cell carcinoma, and initial absence of disseminated lesion.

References

1Choyke PL, White EM, Zeman RK, Jaffe MH, Clark LR. Renal metastases: Clinicopathological and radiologic correlation. Radiology 1987;162:359-63.
2Olsson CA, Moyete JD, Laferte RO. Pulmonary cancer metastatic to the kidney: A common renal neoplasm. J Urol 1971;104 : 492-6.
3Ferrozzi F, Bora D, Compodonico F. Computed tomography of renal metastases. Semin Ultrasound CT MR 1997;18 : 115-21.