Metastatic hypernephroma to the head and neck: unusual case reports and review of the literature

Metastatic Renal Cell Carcinoma Masquerading as Jugular Foramen Paraganglioma: A Role for Novel Magnetic Resonance Imaging

OBJECTIVES

To describe a case of metastatic renal cell carcinoma (RCC) masquerading as a jugular foramen paraganglioma (JP). To compare imaging findings between skull base metastatic RCC and histologically proven paraganglioma.

METHODS

A case of unexpected metastatic skull base RCC is reviewed. Computed tomography (CT) and magnetic resonance imaging (MRI) were compared between 3 confirmed cases of JP and our case of metastatic RCC. Diffusion-weighted MRI (DW-MRI) sequences and computed apparent diffusion coefficient (ADC) values were compared between these entities.

RESULTS

A 55-year-old man presents with what appears clinically and radiographically to be JP. The tumor was resected, then discovered on postoperative pathology to be metastatic RCC. Imaging was retrospectively compared between 3 histologically confirmed cases of JP and our case of skull base RCC. The RCC metastasis was indistinguishable from JP on CT and traditional MRI but distinct by ADC values calculated from DW-MRI.

CONCLUSIONS

Metastatic RCC at the skull base may mimic the clinical presentation and radiographic appearance of JP. The MRI finding of flow voids is seen in both paraganglioma and metastatic RCC. Diffusion-weighted MRI is able to distinguish these entities, highlighting its potential utility in distinguishing skull base lesions.

Isolated thyroid metastasis revealed an unknown lung adenocarcinoma: a case report

INTRODUCTION

Cancer metastasis to the thyroid is extremely rare. The most common sites that have been reported to metastasize to the thyroid gland are breast and kidney. As to primary lung cancer metastasizing to the thyroid gland, only a few cases have been described in the literature.

CASE PRESENTATION

We report a case of a 37-year-old white Arabian woman who had never smoked tobacco products for whom a malignant thyroid mass revealed a primary lung tumor. She had a surgical excision for both the thyroid and the pulmonary tumors, and received adjuvant chemotherapy. At 1 year, she is still in remission.

CONCLUSIONS

Our case is rare as it describes a case where the thyroid lesion was the revealing sign of an unknown lung carcinoma. Management of thyroid metastases should depend on the individual situation and surgical excision should be proposed whenever a patient's condition is favorable.

Dysphagia and dysphonia in a woman with a previous breast cancer

Metastasis to the thyroid occur infrequently. The overall incidence in autopsy series vary from 0-5% in unselected cases to 24% in patients with a known malignancy. They usually occur when there are another metastases, sometimes many years after diagnosis of the original primary tumour. We present the case of a woman with dysphagia and dysphonia due to a thyroid mass as first manifestation of a metastatic breast cancer.

Management of solitary palatal metastasis from renal cell carcinoma

BACKGROUND

A 68-year-old male diagnosed with left-side renal cell carcinoma, and in clinical remission for 3 years following a nephrectomy, presented with a 2-month history of progressive difficulty in swallowing, accompanied by a new growth in the palate. Examination revealed a 25 mm x 25 mm soft-tissue growth at the junction of the hard and soft palate. Systemic examination did not reveal any other evidence of cancer progression.

INVESTIGATIONS

CT scans, nasopharyngoscopy, fine-needle aspiration of palatal lesion and immunohistochemistry of biopsy specimen.

DIAGNOSIS

Solitary palatal metastasis at the junction of the hard and soft palate from renal cell carcinoma.

MANAGEMENT

Local, lesion-directed interferon therapy, repeat nasopharyngoscopy and regular clinical follow-up.

Descending Tumor Thrombus from Renal Cell Carcinoma Metastases with SVC Syndrome

We describe a case of renal cell carcinoma metastases to the thyroid gland invading local veins and extending to the neck veins causing superior vena cava (SVC) syndrome.

Metastases to the thyroid gland: the Royal Marsden experience

AIM

A review of patients seen at the Royal Marsden Hospital with metastases to the thyroid gland.

METHOD

Experience reported on 15 patients that were seen at our institution between 1985 and 2002.

RESULTS

The most common site of origin was the kidney (4/15). Ages ranged between 26 and 76 years. Twelve presented with a neck mass. Most had metastatic disease elsewhere at the time of presentation (9/15). Diagnosis was made by fine needle aspiration cytology (5), tru-cut biopsy (1), or surgery (9); surgery comprised total thyroidectomy (3), subtotal thyroidectomy (3) or lobectomy (3). Radiotherapy resulted in disease stabilisation in three patients. Chemotherapy was used to treat local recurrence in two patients post-operatively. The interval from diagnosis of the primary tumour to thyroid metastasis varied from 0 months to 15 years. Thyroid gland metastasis was the initial manifestation of metastatic disease in five patients. Five patients are alive, with one disease free 7 years following resection of the thyroid metastasis.

CONCLUSIONS

Thyroid metastases are clinically rare, with the kidney the most common primary site of origin. They usually occur when there are metastases elsewhere, sometimes many years after diagnosis of the original primary tumour. Surgical resection of an isolated metastasis may result in prolonged disease-free survival. Radiotherapy and chemotherapy may be of value in specific situations.