Zhang Roy, Lee Chang Woo, Basyuni Shadi, Santhanam Vijay
University of Cambridge School of Clinical Medicine, Box 111 Cambridge Biomedical Campus, Hills Road, Cambridge, CB2 0SP, Cambridge, United Kingdom.
Department of Oral and Maxillo-Facial Surgery, Cambridge University Hospitals, Hills Road, Cambridge, CB2 0QQ, United Kingdom.
Int J Surg Case Rep. 2020;70:96-100. doi: 10.1016/j.ijscr.2020.04.061. Epub 2020 May 11.
Renal cell carcinoma (RCC) is the most common malignant tumour of the kidney. It usually presents in an occult manner, rarely with the classical triad of haematuria, abdominal mass and abdominal pain. Up to a third of patients have metastasis on presentation and only a few case reports have involved the mandible.
We present the case of a renal cell carcinoma that presented, in a 56-year-old lady, with mandibular swelling as its main clinical manifestation. This patient presented with a 3-month history of right sided facial swelling, associated with pain and intermittent paraesthesia to the right side of the tongue and lower lip. Imaging of the mandible revealed a lesion that had caused complete destruction of the right condyle, coronoid and ramus. Ultrasound guided biopsy revealed the nature of the mass to be metastatic renal cell carcinoma. Subsequent computed tomography (CT) imaging of the abdomen and pelvis confirmed the presence of a tumour in the right kidney. Due to the advanced nature of the disease, radical treatment was not suitable, and the patient passed away 11 months after diagnosis with palliative care.
Whilst mandibular swelling is usually benign, it should be kept in mind that orofacial symptoms can be the initial presentation of systemic disease. Persistent swellings with infection ruled out, or those causing cranial nerve palsy, should be investigated further.
肾细胞癌（RCC）是最常见的肾脏恶性肿瘤。它通常以隐匿方式出现，很少出现血尿、腹部肿块和腹痛的经典三联征。高达三分之一的患者在就诊时已有转移，仅有少数病例报告涉及下颌骨。
我们报告一例肾细胞癌病例，患者为一名56岁女性，主要临床表现为下颌肿胀。该患者有3个月右侧面部肿胀病史，伴有疼痛以及右侧舌部和下唇间歇性感觉异常。下颌骨影像学检查显示有一病变，导致右侧髁突、冠状突和下颌支完全破坏。超声引导下活检显示肿块性质为转移性肾细胞癌。随后的腹部和盆腔计算机断层扫描（CT）成像证实右肾存在肿瘤。由于疾病已处于晚期，根治性治疗不合适，患者在诊断后11个月接受姑息治疗后去世。
虽然下颌肿胀通常为良性，但应记住口面部症状可能是全身性疾病的首发表现。排除感染因素的持续性肿胀或导致颅神经麻痹的肿胀，应进一步检查。
