metastases in the head neck region from renal cell carcinoma ( rcc ) are seen in less than 15% of patients with metastatic disease . majority of the times , it is a manifestation of widespread metastases in a known case of rcc , but such lesions can be the initial presentation of the disease . primary localizing sites in the head neck region include nodal and soft tissue metastases , sinonasal region , nasopharynx , parotid , larynx , thyroid gland , orbit , and tongue . lingual metastases on the dorsum , ventrum , lateral border , and tip are more frequently reported than metastases to base tongue . a 48-year - old gentleman was diagnosed as a case of left - sided rcc in june 2004 , which was treated with radical nephrectomy and adjuvant radiotherapy at an outside hospital . in october 2006 , he presented to our hospital for second opinion in view of progressive metastatic deposits in both the adrenals , lungs , and mediastinum . he was started on interferon ( inf- , 5 miu daily subcutaneous doses ) , which he continued till december 2007 . he was advised external beam radiotherapy for the base tongue lesion but refused treatment due to personal reasons . in december 2009 he was barely able to swallow liquids orally and had lost 2 - 3 kg of weight . on clinical examination , he had a large ( 5  5 cm ) exophytic swelling in the oropharynx with epicenter in the right base of tongue [ figure 1 ] . it involved the tonsillar fossa and adjacent soft palate on right side , crossing midline . computerized tomography ( ct ) scan of the face , neck , thorax , abdomen , and pelvis was suggestive of widespread visceral and osseous deposits apart from the base tongue lesion [ figure 2 ] . no adenopathy was noted ( which corroborated with secondary from rcc as it is uncommon for large oropharyngeal primary of squamous carcinoma to present without neck nodes ) . in view of predominant symptom of dysphagia and exophytic growth , the patient received radiotherapy to a dose of 50 gy in 25 fractions over 5 weeks with limited portals . protracted regimen ( prolonged fractionated course of radiotherapy over 5 weeks as compared to the most commonly used short course of palliative radiotherapy ) was chosen expecting sustained and relatively quicker relief of symptoms . by the end of treatment subsequently , he was referred to medical oncologist for targeted therapy . till the time of last follow - up ( 3 months postradiotherapy ) , durable response at the base tongue lesion was documented but unfortunately he was yet to start targeted therapy due to financial issues . ( b ) regression of base tongue metastases after palliative radiotherapy contrast - enhanced ct scan of face and neck illustrating the right base tongue metastasis the kidney is third common primary infraclavicular location of malignant neoplasms metastasizing to head and neck . tongue base is a peculiar favorable site for metastases due to its rich vascular supply . early lesions may be asymptomatic or present with some discomfort in the throat , while moderate to large size lesions may present with either dysphagia and change in voice ( as in the present case ) or develop bleeding and pain at the local site . review of base tongue metastases from renal cell carcinoma the rarity of this bizarre site of metastases can create a diagnostic dilemma . primary malignant clear cell tumors of the head and neck arising from the salivary , thyroid , or parathyroid glands and secondaries from lung and female genital tract form the diagnostic differentials . cross - sectional imaging would be helpful for lingual metastases which show high signal due to their vascular nature or occurrence of intralesional hemorrhage . renal cell carcinoma even with metastatic disease has a protracted clinical course and patients survive relatively longer as compared to metastatic disease from other histologies . hence renal metastatic disease is comparatively treated more aggressively with an intent to contain the disease for relatively longer time and achieve sustained palliation . based on the reports in literature , surgical excision is recommended as the primary treatment for base tongue metastases , provided good structural and functional outcome can be achieved . however , prognosis for patients with lingual metastasis of rcc with disseminated disease has been reported to be poor despite aggressive local treatment . the aim is primarily to provide relief from dysphagia and pain while preventing bleeding and infection . radiation therapy and immunotherapy or immune - chemotherapy for palliation of lingual metastases has produced encouraging results . contrary to the traditional belief of relative radio- and chemo - resistance of rcc metastases , secondary lingual lesions from rcc have responded remarkably to 5 weeks of protracted radiation therapy as well as to 1 month of inf- therapy . infact , it was concluded by the authors that tongue is a possible sensitive site to ifn- therapy as better response as compared to pulmonary , bone , and lymph node metastases was noted . with regards to the efficacy of radiation therapy for base tongue metastases per se , authors have not come across any report in literature . considering the possibility of avoiding a major surgical intervention and expecting a better functional outcome , radiation therapy is an acceptable palliative strategy . on the other hand , as compared to inf- palliative radiotherapy produces prompt relief of pain , bleeding , and dysphagia . the kidney is third common primary infraclavicular location of malignant neoplasms metastasizing to head and neck . tongue base is a peculiar favorable site for metastases due to its rich vascular supply . early lesions may be asymptomatic or present with some discomfort in the throat , while moderate to large size lesions may present with either dysphagia and change in voice ( as in the present case ) or develop bleeding and pain at the local site . review of base tongue metastases from renal cell carcinoma the rarity of this bizarre site of metastases can create a diagnostic dilemma . primary malignant clear cell tumors of the head and neck arising from the salivary , thyroid , or parathyroid glands and secondaries from lung and female genital tract form the diagnostic differentials . cross - sectional imaging would be helpful for lingual metastases which show high signal due to their vascular nature or occurrence of intralesional hemorrhage . renal cell carcinoma even with metastatic disease has a protracted clinical course and patients survive relatively longer as compared to metastatic disease from other histologies . hence renal metastatic disease is comparatively treated more aggressively with an intent to contain the disease for relatively longer time and achieve sustained palliation . based on the reports in literature , surgical excision is recommended as the primary treatment for base tongue metastases , provided good structural and functional outcome can be achieved . however , prognosis for patients with lingual metastasis of rcc with disseminated disease has been reported to be poor despite aggressive local treatment . the aim is primarily to provide relief from dysphagia and pain while preventing bleeding and infection . radiation therapy and immunotherapy or immune - chemotherapy for palliation of lingual metastases has produced encouraging results . contrary to the traditional belief of relative radio- and chemo - resistance of rcc metastases , secondary lingual lesions from rcc have responded remarkably to 5 weeks of protracted radiation therapy as well as to 1 month of inf- therapy . infact , it was concluded by the authors that tongue is a possible sensitive site to ifn- therapy as better response as compared to pulmonary , bone , and lymph node metastases was noted . with regards to the efficacy of radiation therapy for base tongue metastases per se , authors have not come across any report in literature . considering the possibility of avoiding a major surgical intervention and expecting a better functional outcome , radiation therapy is an acceptable palliative strategy . on the other hand , as compared to inf- palliative radiotherapy produces prompt relief of pain , bleeding , and dysphagia . the kidney is third common primary infraclavicular location of malignant neoplasms metastasizing to head and neck . tongue base is a peculiar favorable site for metastases due to its rich vascular supply . early lesions may be asymptomatic or present with some discomfort in the throat , while moderate to large size lesions may present with either dysphagia and change in voice ( as in the present case ) or develop bleeding and pain at the local site . primary malignant clear cell tumors of the head and neck arising from the salivary , thyroid , or parathyroid glands and secondaries from lung and female genital tract form the diagnostic differentials . cross - sectional imaging would be helpful for lingual metastases which show high signal due to their vascular nature or occurrence of intralesional hemorrhage . renal cell carcinoma even with metastatic disease has a protracted clinical course and patients survive relatively longer as compared to metastatic disease from other histologies . hence renal metastatic disease is comparatively treated more aggressively with an intent to contain the disease for relatively longer time and achieve sustained palliation . based on the reports in literature , surgical excision is recommended as the primary treatment for base tongue metastases , provided good structural and functional outcome can be achieved . however , prognosis for patients with lingual metastasis of rcc with disseminated disease has been reported to be poor despite aggressive local treatment . the aim is primarily to provide relief from dysphagia and pain while preventing bleeding and infection . radiation therapy and immunotherapy or immune - chemotherapy for palliation of lingual metastases has produced encouraging results . contrary to the traditional belief of relative radio- and chemo - resistance of rcc metastases , secondary lingual lesions from rcc have responded remarkably to 5 weeks of protracted radiation therapy as well as to 1 month of inf- therapy . infact , it was concluded by the authors that tongue is a possible sensitive site to ifn- therapy as better response as compared to pulmonary , bone , and lymph node metastases was noted . with regards to the efficacy of radiation therapy for base tongue metastases per se , authors have not come across any report in literature . considering the possibility of avoiding a major surgical intervention and expecting a better functional outcome , radiation therapy is an acceptable palliative strategy . on the other hand , as compared to inf- palliative radiotherapy produces prompt relief of pain , bleeding , and dysphagia . it should be considered in the differential diagnosis of malignant tumors with clear cell histologic pattern . base tongue metastases from rcc are exquisitely responsive to both radiation therapy as well as immunotherapy and form acceptable palliative strategies .
base tongue involvement is a rare presentation of lingual metastases from renal cell carcinoma . 
 a 48-year - old gentleman was treated with open radical nephrectomy and adjuvant radiotherapy for stage ii furhman grade i clear cell carcinoma of the left kidney at an outside hospital . 
 he presented metachronously 5 years later with progressive dysphagia and change of voice . 
 clinicoradiological evaluation revealed a large exophytic mass in the oropharynx with epicenter in the right base of tongue . 
 metastatic workup revealed widespread dissemination to multiple organs and bone . in view of predominant symptom of dysphagia , 
 base tongue metastasis was treated with protracted course of palliative radiotherapy to a dose of 50 gy in conventional fractionation over 5 weeks . 
 this resulted in excellent and durable response at the base tongue lesion ( till the time of last follow - up ) . 
 radiation therapy is an acceptable palliative strategy for advanced lingual metastasis as it produces prompt relief of pain , bleeding , and dysphagia .