PMC2913808_01
CT of neck with contrast. (a) Well-defined tumour mass in the right submandibular gland measuring 29 x 26 x 30 mm. It shows prominent vascularisation which would be unusual for benign lesion such as PA. There is some low-density area centrally in the tumour probably related to necrosis. (b) There is a large nodule in the thyroid on the right side measuring 26 x 23 x 30 mm showing similar intense enhancement as the submandibular lesion.
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fig1
A computed tomography (CT) scan of her neck was performed which revealed a tumour mass in the right submandibular gland with prominent vascularisation unusual for benign lesions such as a PA (Figure 1). CT scan also showed a large nodule in the right thyroid with similar intense vascular enhancement as the submandibular lesion (Figure 1).
(a) Original renal tumour (H&E stain, original magnification x40). On the left is normal kidney and clear cell RCC is on the right. (b) Submandibular gland (H&E stain, original magnification x40): metastatic RCC on the top with normal glandular tissue in the lower portion. (c) Metastatic RCC in submandibular gland (H&E stain, original magnification x200). (d) Thyroid tumour (H&E stain, original magnification x40): tumour on the left and normal thyroid tissue on the right.
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fig2
Histopathological examination of the tumour showed striking similarity to the clear cell RCC of left kidney resected previously (Figure 2). Histopathological analysis of right lobe of thyroid gland confirmed metastatic clear cell RCC similar to the submandibular gland disease (Figure 2).