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23 May 2013 - Case of the Week #274
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Thanks to Dr. Rizwan Bashir, Aga Khan University Hospital (Pakistan), for contributing this case and the discussion. To contribute a Case of the Week, follow the guidelines on our Case of the Week page.
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Case of the Week #274
A 65 year old man presented with swelling around the alveolar region of his teeth and gums for 1 year. Due to a prior history of malignancy, an excision was performed.
What is your diagnosis?
Metastatic classic renal cell carcinoma of alveolar mucosa / teeth region
Left to right: CAM5.2+, CK7-, CK20-, CD10 variable
Metastases to the oral cavity are often to the gingiva or tongue. Common primaries include lung, as well as breast, endometrium, melanoma, prostate and renal cell carcinoma (J Cancer Res Ther 2013;9:105). In this case, the patient had a prior history of renal cell carcinoma, and the tumor cells had the classic pattern of CAM5.2+, CK7-, CK20-. CD10 is usually positive, and positive staining for RCC, PAX2 and PAX8 may be helpful (see PathologyOutlines.com topic.)
The differential diagnosis includes clear cell mucoepidermoid carcinoma (may have somewhat similar histology, but typically involves major or minor salivary glands, has three types of cells with no alveolar pattern, has no prominent vasculature, and is CD10-, vimentin-, Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2010;109:e22). Other odontogenic clear cell carcinomas must also be ruled out (World J Surg Oncol 2006;4:91).
Nat Pernick, M.D., President
and Palak Thakore, Associate Medical Editor
30100 Telegraph Road, Suite 408
Bingham Farms, Michigan (USA) 48025
Alternate email: NatPernick@gmail.com