Management of Recurrent Metastasis of Renal Cell Carcinoma to the Parotid Gland After Nephrectomy

Renal cell carcinoma accounts for 90% of malignant renal tumors, with common metastases to the lungs, bones, and brain. Head and neck metastases are uncommon, and the parotid gland is an exceedingly rare site (0.5%). Recurrent metastasis to bilateral parotid glands has been reported in the literature, but recurrent metastasis to the ipsilateral gland has not. This is a case about a 69-year-old female who presented to our clinic with the chief complaint of a slowly enlarging left neck mass. She had a history of clear cell renal cell carcinoma treated with nephrectomy 15 years prior. An MRI reviewed from 2 years earlier incidentally noted a left parotid tail lesion that had not been evaluated. CT and fine needle aspiration biopsy raised concern for malignancy. The patient underwent superficial parotidectomy, which confirmed metastatic clear cell renal cell carcinoma. Surveillance imaging was recommended but not completed. Two years later, she re-presented with recurrence in the same parotid gland. A multidisciplinary tumor board recommended surgery with preservation of the facial nerve, followed by radiation and immunotherapy. This case underscores the unpredictable metastatic pattern of renal cell carcinoma and the importance of long-term surveillance even beyond recommended guidelines. Clinicians should maintain a high index of suspicion for metastatic renal cell carcinoma in patients with a history of nephrectomy presenting with a parotid mass, given the potential for late recurrence.