lung and breast cancers are the most common to metastasize to the head and neck region , followed by renal cell carcinoma ( rcc ) . at this site , very few cases of tongue lesion leading to diagnosis of a renal primary have been reported in the literature . this paper reports a case of a 63-year gentleman , chronic smoker , presented with progressively increasing swelling over dorsal surface of tongue with difficulty in swallowing for last 3 months . on examination a 3  3 cm superficial , mobile , pedunculated , proliferative growth was seen in midline of dorsal surface of tongue [ figure 1 ] . in view of histopathology , computed tomography ( ct ) scan of neck , chest and abdomen was done which revealed a 5  6  5 cm heterogeneously enhancing lesion in mid - region extending to upper pole of right kidney with multiple bilateral sub - centimeter lung nodules [ figure 2 ] . fluoride positron emission tomography - ct done as a part of metastatic work - up did not reveal any other site of metastases . image showing tongue metastases computed tomography scan showing right renal mass patient underwent right cytoreductive nephrectomy along with wide excision of tongue metastases . histopathology of kidney mass confirmed the diagnosis of conventional clear cell carcinoma with fuhrman 's grade one ( pt1bn0 ) . patient was started post - operatively on sunitinib in view of residual metastatic lung lesions . rcc predominantly occurs in males ( 1.5:1 ) with peak incidence in the sixth decade . approximately 30% of newly diagnosed rcc patients present with synchronous metastatic disease , and an additional 25 - 30% of patients with clinically localized disease eventually develop metastases . metastases in the head neck region from rcc are seen in 8 - 15% of patients with metastatic disease . usually , it is a manifestation of widespread metastases in a known case of rcc , but at times such lesions can also lead to detection of a silent rcc . primary localizing sites in the head neck region include paranasal sinuses , larynx , jaws , temporal bones , thyroid gland and parotid glands . lingual metastases represent only about 1% incidence of metastases to oral cavity and arise most commonly from melanomas , breast , gastrointestinal tract , lung and rarely from kidney . from 1973 to 2011 , 33 cases of a lingual metastasis of a primary kidney tumor were published in the english - language literature . until today , only 7 patients have presented primarily with tongue metastases leading to the diagnosis of rcc [ table 1 ] . previous reports of metastasis of tongue it has been postulated that in the absence of lung or liver lesions , the disease can spread through batson 's venous plexus or thoracic duct . most tongue metastases involve the base due to its high vascularity and low mobility . however , our patient had a dorsal midline lesion in tongue . like primary tongue lesions , lingual metastases can be ulcerated or polypoid and tumor cells can infiltrate the muscle without involving the overlying mucosa . tomita et al . in their review of 18 cases of rcc with lingual metastases , considered this site to be associated with poor prognosis : the rarity of this site of metastases can create a diagnostic dilemma in patients with clear cell histology . malignant clear cell tumors of the head and neck arise as primary from the salivary , thyroid , or parathyroid glands and as secondaries from lung , female genital tract and kidney . cytoreductive nephrectomy is justified in patients with metastatic disease to improve quality of life or local symptoms . prospective trials have demonstrated that , in patients with synchronous metastatic disease , cytoreductive nephrectomy and cytokine therapy give a distinct survival advantage over immunotherapy alone . several retrospective studies have suggested that patients undergoing complete resection of limited metastatic foci may experience long disease free intervals , with median 5 year survival rate of 35 - 50% in some reports . in a report by kyan and kato , surgical resection of lingual metastases followed by administration of interferon - alpha and interleukin - ii had a disease free interval of 2 years . many prospective trials have shown a prolongation of progression free survival and higher response rates with targeted molecular therapy in metastatic disease . tongue is a rare site for rcc metastases and in very few patients it has led to detection of an otherwise silent rcc . renal evaluation for primary should be considered in differential diagnosis of tongue lesion with clear cell histology . patients can achieve long disease free survival with combination of surgical excision and molecular therapy .
renal cell carcinoma ( rcc ) has the propensity to metastasize to any organ in the body . 
 tongue metastases from rcc is very rare with most of them being metachronous in nature . 
 we present a rare case where patient presented with a tongue lesion leading to a diagnosis of rcc . 
 surgery is the preferred modality of treatment for tongue metastases .