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      Metástasis parotídea de carcinoma de células claras renal con presencia simultánea de pseudoaneurisma arterial. Caso clínico y revisión de la literatura Translated title: Parotid metastasis of clear cell renal carcinoma with simultaneous presence of arterial pseudoaneurysm. Case report and review of literature

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          Abstract

          RESUMEN Las metástasis en glándula parótida son muy poco frecuentes. Presentamos el caso de una mujer de 73 años cuyos antecedentes oncológicos principales a destacar son carcinoma ductal infiltrante de mama tratado con mastectomía y linfadenectomía axilar y, posteriormente, carcinoma de células renales de célula clara bilaterales metacrónicos tratados con nefrectomía radical. Desde entonces la mujer se encuentra en diálisis. Presenta tumoración en parótida de 4 cm, que radiológicamente es catalogada como pseudoaneurisma arterial intraparotídeo. Tras la extirpación de la parótida, seis años después de la última nefrectomía, en el estudio anatomopatológico se observa, junto a vasos dilatados, lesión neoplásica compatible morfológica e inmunohistoquímicamente con metástasis de carcinoma de células renales de célula clara. Se ha realizado una profunda revisión de la literatura encontrando menos de 60 casos descritos de metástasis parotídea de carcinoma de células renales de célula clara. Analizándolos observamos metástasis en otros lugares en el 61 % de los mismos, principalmente pulmonares, óseas y en glándulas adrenales, existiendo mayor porcentaje de segundas metástasis (70 %) cuando hay sincronía entre carcinoma renal y metástasis parotídea. En conclusión, presentamos un caso inusual de metástasis tardía de carcinoma renal de célula clara en parótida, y el primero, según nuestro conocimiento, que se diagnostica como hallazgo incidental en la extirpación de un aneurisma intraparotídeo.

          Translated abstract

          ABSTRACT Parotid gland metastases are very rare. We present the case of a 73-year-old woman whose main oncological history to highlight is infiltrating ductal carcinoma of the breast treated with mastectomy and axillary lymphadenectomy and after that. metachronous bilateral clear cell renal cell carcinoma treated with radical nephrectomy. Since then, the woman has been on dialysis. It presents a 4 cm parotid tumor, which is radiologically classified as an intraparotid arterial pseudoaneurysm. After extirpation of the parotid gland, six years after the last nephrectomy, in the pathological study, together with dilated vessels, a neoplastic lesion compatible morphologically and immunohistochemically with metastasis of clear cell renal cell carcinoma is observed. A thorough review of the literature has been carried out, finding less than 60 reported cases of parotid metastasis from clear cell renal cell carcinoma. Analyzing them, we observed metastases in other places in 61 % of them, mainly lung, bone and adrenal glands, with a higher percentage of second metastases (70 %) when there was a synchrony between renal carcinoma and parotid metastasis. In conclusion, we have presented an unusual case of late metastasis of clear cell renal carcinoma in the parotid, and the first -to our knowledge-, which is diagnosed as an incidental finding in the removal of an intraparotid aneurysm.

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          Most cited references54

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          Parotid gland metastasis from renal cell carcinoma.

          To discuss the diagnosis and management of metastatic renal cell carcinoma presenting as a parotid mass by studying such cases. Retrospective review. Identification of 24 previously reported cases of renal cell carcinoma metastatic to the parotid gland in the English language literature and an analysis of a total of 25 patients including our case. Parotid metastasis was the initial presenting sign of the malignancy in the kidney in 14 of 25 (56%) cases; 11 of 25 (44%) cases presented with metachronous metastasis to the parotid. The most common presenting complaint was parotid mass. No case presented with facial paralysis. In three of six (50%) patients, fine-needle aspiration biopsy was diagnostic. In the majority of cases, parotid metastases are the first clinical sign of the renal cell carcinoma. Fine-needle aspiration biopsy can provide crucial information without parotidectomy as in our case. Parotidectomy with facial nerve preservation should be considered as a therapeutic option for solitary parotid metastasis.
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            Diagnostic relevance of metastatic renal cell carcinoma in the head and neck: An evaluation of 22 cases in 671 patients

            ABSTRACT Purpose Renal cell carcinoma (RCC) is a malignant tumor that metastasizes early, and patients often present with metastatic disease at the time of diagnosis. The aim of our evaluation was to assess the diagnostic and differential diagnostic relevance of metastatic renal cell carcinoma (RCC) with particular emphasis on head and neck manifestations in a large patient series. Patients and methods We retrospectively evaluated 671 consecutive patients with RCC who were treated in our urology practice between 2000 and 2013. Results Twenty-four months after diagnosis, 200/671 (30%) of RCC had metastasized. Distant metastases were found in 172 cases, with 22 metastases (3.3%) in the head and neck. Cervical and cranial metastases were located in the lymph nodes (n=13) and in the parotid and the thyroid gland, tongue, the forehead skin, skull, and paranasal sinuses (n=9). All head and neck metastases were treated by surgical excision, with 14 patients receiving adjuvant radiotherapy and 9 patients receiving chemotherapy or targeted therapy at some point during the course of the disease. Five patients (23%) survived. The mean time of survival from diagnosis of a head and neck metastasis was 38 months, the shortest period of observation being 12 months and the longest 83 months. Discussion and conclusion Our findings show that while RCC metastases are rarely found in the neck, their proportion among distantly metastasized RCC amounts to 13%. Therefore, the neck should be included in staging investigations for RCC with distant metastases, and surgical management of neck disease considered in case of resectable metastatic disease. Similarly, in patients presenting with a neck mass with no corresponding tumor of the head and neck, a primary tumor below the clavicle should be considered and the appropriate staging investigations initiated.
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              Histopathological findings in parotid gland metastases from renal cell carcinoma.

              Metastatic tumours involving the parotid gland arising from non-head and neck origin are rare. Immunohistochemistry has improved the differential diagnosis of these lesions. Current immunohistochemical markers allow the distinction between a number of potential primary tumours (e.g., lung, kidney and breast). We present the clinical and histomorphological features of three renal cell carcinoma (RCC) patients presenting with a parotid mass, review the literature of various non-head and neck malignancies metastasizing to the parotid gland, and discuss their differential diagnosis. Two females and one male, aged 58 to 76 years, presented with a parotid tumour of renal cell origin. In one case, the parotid mass was the first clinical manifestation. In the two other cases, a nephrectomy had been performed 5-9 years earlier because of RCC. The cases showed a highly vascular parotid lesion causing difficulty in interpretation of the fine needle aspirate. Two patients underwent a superficial parotidectomy and one patient an open biopsy of the parotid gland tumour. Immunohistochemical stainings for vimentin, CD10 and PNRA were positive suggesting renal cell origin, which was later confirmed. Clinical and radiological evaluations and diagnosis by fine needle aspiration may prove difficult partly due to the vascular nature of parotid metastasis of renal cell carcinoma. Immunohistochemical staining is useful in identifying the primary tumour.
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                Author and article information

                Journal
                maxi
                Revista Española de Cirugía Oral y Maxilofacial
                Rev Esp Cirug Oral y Maxilofac
                Sociedad Española de Cirugía Oral y Maxilofacial y de Cabeza y Cuello (Madrid, Madrid, Spain )
                1130-0558
                2173-9161
                September 2022
                : 44
                : 3
                : 112-118
                Affiliations
                [3] Murcia orgnameHospital General Universitario Reina Sofía orgdiv1Servicio de Cirugía Maxilofacial España
                [1] Murcia orgnameHospital General Universitario Reina Sofía orgdiv1Servicio de Anatomía Patológica España
                [4] Murcia orgnameHospital General Universitario Morales Meseguer orgdiv1Servicio de Oncología Médica España
                [5] El Palmar, Murcia orgnameHospital Clínico Universitario Virgen de la Arrixaca orgdiv1Servicio de Cirugía General España
                [2] Murcia Murcia orgnameUniversidad de Murcia Spain
                Article
                S1130-05582022000300004 S1130-0558(22)04400300004
                10.20986/recom.2022.1370/2022
                fe93cfc9-52c6-4fd4-91f1-ebb1fa73dc2a

                This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

                History
                : 05 October 2022
                : 20 May 2021
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 55, Pages: 7
                Product

                SciELO Spain

                Categories
                Revisión

                immunohistochemistry,Parótida,metástasis,carcinoma de células renales de célula clara,inmunohistoquímica,pseudoanerisma,Parotid gland,metastases,clear cell renal cell carcinoma,pseudoaneurysm

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