Metastasis of renal cell carcinoma to the head and neck as first manifestation of disease: a case series

Introduction: Renal cell carcinoma (RCC) is an aggressive tumour originating from renal tubular epithelium, commonly metastasizing to the lungs, bones, liver, brain, and lymph nodes. Metastasis to the head and neck occurs in only about 15% of cases, and it is even rarer for a head and neck lesion to be the initial manifestation of RCC. Methods: We conducted a 12-year case series of patients presenting to otolaryngology clinics with head and neck manifestations of metastatic RCC. Primary renal tumors were identified on ultrasound and confirmed histologically, and cases lacking imaging or histologic confirmation were excluded. Descriptive analyses were performed using Microsoft Excel (Version 16.85). Results: Of 41 patients with metastatic head and neck lesions, 15 (36.6%) had a confirmed renal primary on imaging and biopsy and were included. The cohort showed a male predominance with a median age of 55 years. The nasal cavity was the most common site, typically presenting with epistaxis, followed by the scalp. All tumors showed clear cell morphology with positivity for Cytokeratin Cam 5.2, Pax8, and RCC, and negativity for CK7 and CK20. Most patients had no distant metastases, with fewer than one-quarter demonstrating brain involvement. Over half received chemotherapy or radiotherapy, and about one-quarter underwent nephrectomy. Conclusion: Metastatic RCC should always be considered in the differential diagnosis of rapidly growing, hypervascular lesionsin the head and neck region, including skull base masses, particularly in men in their 50–70s, who represent a high-risk demographic.