Renal cell carcinoma is the most common renal tumor in adults. Clear cell carcinoma represents 85% of all histological subtypes. In February 2012 a 72-year-old woman came to our department due to the appearance of massive hemoptysis and pharyngodinia. Previously, this patient was diagnosed with a renal cell carcinoma treated with left nephrectomy. We observed an exophytic, grayish, and ulcerated mass in the left tonsillar lodge and decided to subject the patient to an immediate tonsillectomy. Postoperative histology showed nests of cells with highly hyperchromatic nuclei and clear cytoplasm. These features enabled us to make the diagnosis of renal clear cell carcinoma metastasis. Only few authors described metastasis of renal cell carcinoma in this specific site. 1. Introduction Renal cell carcinoma (RCC) is the most common renal tumor in adults. In 85% of cases clear cell carcinoma is the histological subtype. RCC metastasizes mainly to the lung, liver, or bones while head and neck metastases are extremely rare, with possible lesions to the parotid gland, thyroid, paranasal sinuses, and skull [1–3]. In this report we present a rare case of RCC metastasis to the tonsil lodge, which appeared 3 years after left nephrectomy. In the English-language literature only few authors described this site of RCC metastasis [4–8]. 2. Case Report In February 2012 a 72-year-old woman came to our department due to the appearance of massive hemoptysis, pharyngodinia, and dysphagia. In 2009, this patient was diagnosed with a renal clear cell carcinoma treated with left nephrectomy. A control CT performed 6 months later showed 2 subpleural pulmonary nodules of about 10？mm in diameter, referable to carcinoma metastases. Therefore, subsequently, the patient was subjected to 6 cycles of chemotherapy treatment. Pharyngoscopy revealed an exophytic, grayish, and ulcerated mass in the left tonsillar lodge. It measured about 4？cm in maximum diameter and was friable, painful to pressure, and covered with serosanguineous material. No laterocervical lymphadenopathy was evident at neck palpation. Due to the significant bleeding we subjected the patient to immediate surgery. We were able to remove the tonsil mass stopping the bleeding (Figure 1). At intraoperative observation the neoformation did not show infiltration of neighboring structures. Figure 1: Exophytic, grayish, and ulcerated mass in the left tonsillar lodge (intraoperative image). At postoperative histology nests of cells coated with Malpighian epithelium delimited by fibrous septa were evident. Cells showed highly
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