Metastatic hypernephroma of the parotid gland.

Case report A 71-year-old Caucasian female first presented in November 1977 with a painless swelling of the right parotid region of 9 months' duration. Examination demonstrated a pulsatile, mobile swelling situated just below the right angle of mandible, approximately 4 cm in diameter (Fig. 1). The swelling showed the sign of emptying. In addition, a right Horner's syndrome was noted. No bruit was heard. A routine chest X-ray showed a space-occupying lesion in the apex of the right lung. At this time the patient refused further investigation and failed to attend for review. In October 1978 she presented to the Urology Department with painful haematuria. Intravenous pyelography showed changes consistent with a neoplasm of the left kidney. At operation a hypernephroma involving the lower pole of the left kidney was confirmed. Histology showed a clear cell carcinoma of kidney with penetration of the capsule by tumour. She made a satisfactory postoperative recovery. No investigations of the swelling in her neck were carried out at this time. In November 1979 she complained that the swelling in the right parotid region had increased in size and agreed to further investigations. FIG. 1. Pre-operative appearance showing the right parotid swelling.