Mandibular swelling as the initial presentation for renal cell carcinoma: A case report

INTRODUCTION: 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. PRESENTATION OF CASE: 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. DISCUSSION AND CONCLUSION: 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.