gms | German Medical Science

Introduction: Differential diagnosis of bilateral vocal cord paralysis includes malignant processes affecting the recurrent nerve including metastases. A generally unexpected primary of metastases in the head and neck region is renal clear cell carcinoma. This most common, malignant kidney tumor has a high metastatic potential. 15% of these metastases occur in the head and neck region.

Results: A 77 year old patient presented with dyspnea and stridor due to bilateral recurrent nerve paralysis. Emergency tracheostomy was performed. In the course of further diagnostics a CT scan of thorax and abdomen revealed a RCCC of the right kidney which was surgically removed. Imaging furthermore revealed suspect cervical lesions that were biopsied multiply during panendoscopy and finally openly in the laryngeal and thyroid area without pathohistological proof of a malignant mass. Only inflammatory processes were seen. Due to these unexpected results diagnosis of the perilaryngeal metastasis was delayed. After another open approach supported the suspected origin of the mass and revealed laryngeal and thyroidal invasion of the metastasis, total laryngectomy, thyroidectomy and bilateral modified radical neck dissection was performed.

Discussion: Metastases of renal clear cell carcinoma can evade pathohistological diagnosis and lead to a delayed clinical course. Repetitive and invasive surgical treatment can be the result. If renal clear cell carcinoma is suspected, diagnosis should be attained aggressively since the optimal treatment of solitary metastasis from this tumor remains complete surgical resection.