title: An upper lip tumour as the presenting symptom of metastatic renal cancer.
abstract: BACKGROUND
  Renal cell carcinoma (RCC) constitutes about 3% of solid tumours in adults. Unfortunately, in spite of continuous development of more and more efficient diagnostic methods, in about 30% of patients with RCC metastatic spread is found at presentation. Only in 1% of patients with advanced RCC metastases are limited exclusively to the head-and-neck region. We present a case of a male patient in whom a tumour of the upper lip was the first symptom of advanced renal cancer.
  
  
  METHODS
  A 59-year-old male was admitted to the Urology Department due to a large tumour of the right kidney. About two months earlier the patient noted a nodule located within the upper lip. In the same period painless hematuria occurred twice, which was disregarded by the patient. A CT scan of the chest and abdomen showed a large tumour of the kidney, multiple lung and bone metastases. The patient underwent local surgical excision of the lip tumour and palliative renal artery embolization.
  
  
  CONCLUSIONS
  In natural history of renal cancer there is a risk of metastatic spread to the head-and-neck region. Contrast enhanced computed tomography of the abdomen should be considered if a tumour of unknown origin is found within the head-and-neck region. Prognosis in case of confirmed metastatic renal cancer is unfavourable and patient's treatment should be conducted in specialist centres.
authors.affiliation: Klinika Urologii, Wojskowy Instytut Medyczny, ul. Szaserów 128, 04-141 Warszawa. tsyrylo@wp.pl
authors.forename: Tomasz
authors.initials: T
authors.lastname: Syryło
authors.forename: Agnieszka
authors.initials: A
authors.lastname: Syryło
authors.forename: Dariusz
authors.initials: D
authors.lastname: Jurkiewicz
authors.forename: Henryk
authors.initials: H
authors.lastname: Zieliński
authors.forename: Tomasz
authors.initials: T
authors.lastname: Pietka
mesh_terms: D002292:Carcinoma, Renal Cell / Q000556:secondary* / Q000601:surgery*; D017809:Fatal Outcome; D006801:Humans; D007680:Kidney Neoplasms / Q000473:pathology* / Q000601:surgery*; D008048:Lip Neoplasms / Q000556:secondary* / Q000601:surgery*; D008297:Male; D008875:Middle Aged