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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.

July 15-19, 2013
Snow King Resort
Jackson, Wyoming

30th Annual Summer Update
In Clinical Immunology, Microbiology, and Infectious Diseases

This 24.25 hour review and update in the areas of clinical immunology, microbiology, and infectious diseases is intended to improve knowledge about the pathogenesis and clinical manifestations of infectious diseases, immunological mechanisms of disease and disease prevention, appropriate approaches to the diagnosis of infections and immunologic disorders, and utilization of the clinical microbiology and immunology laboratory including selection and interpretation of results.

This course will provide a forum for the exchange of ideas dealing with microbial infections as well as immunity to infectious diseases and immunologic disorders. Faculty consists of clinicians involved in patient care, pathologists, and clinical laboratory scientists. Discussion of timely topics by faculty and participants assures that this course will be informative, interesting, and relevant.

Course Directors:
Harry R. Hill, MD
Larry G. Reimer, MD
Judy A. Daly, PhD



Website news:

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(2) We posted two new articles on our Management Page:   Commercial Insurance Plans following the Technical Component (TC) Grandfather Changes, by Mick Raich, President, Vachette Pathology, and State Guidance Limits EHR Donations, by Leigh Polk, Business Support Services Director, McKesson Revenue Management Solutions.

(3) We are in the process of updating many chapters and in doing so, some of our internal links temporarily will not work. When a chapter update is complete, the links should be working again. We apologize for the inconvenience.

Case of the Week #274

Clinical History:

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.

Gross images:

Micro images:

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
PathologyOutlines.com, Inc.
30100 Telegraph Road, Suite 408
Bingham Farms, Michigan (USA) 48025
Telephone: 248/646-0325
Email: NatPernick@Hotmail.com
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