Metastatic Renal Cell Carcinoma Presenting as a Paranasal Sinus Mass: The Importance of Differential Diagnosis

Abstract

Metastases in the paranasal sinuses are rare; renal cell carcinoma is the most common cancer that metastasizes to this region. We present the case of a patient with a 4-month history of a rapidly growing mass of the nasal pyramid following a nasal trauma, associated with spontaneous epistaxis and multiple episodes of hematuria. Cranial CT scan and MRI showed an ethmoid mass extending to the choanal region, the right orbit, and the right frontal sinus with an initial intracranial extension. Patient underwent surgery with a trans-sinusal frontal approach using a bicoronal incision combined with an anterior midfacial degloving; histological exam was compatible with a metastasis of clear cell renal cell carcinoma. Following histological findings, a total body CT scan showed a solitary 6 cm mass in the upper posterior pole of the left kidney identified as the primary tumor. Although rare, metastatic renal cell carcinoma should always be suspected in patients with nasal or paranasal masses, especially if associated with symptoms suggestive of a systemic involvement such as hematuria. A correct early-stage diagnosis of metastatic RCC can considerably improve survival rate in these patients; preoperative differential diagnosis with contrast-enhanced imaging is fundamental for the correct treatment and follow-up strategy.

Atypical metastasis of renal cell carcinoma to the uvula: case report and review of literature

“…7 RCC is the most common malignancy that metastasizes to this region. 8 , 9 The most common path via which RCC cells spread to the sinonasal region includes that via the inferior vena cava–heart–maxillary artery as well as via the avalvular vertebral venous plexus and the intracranial venous plexus. 9 The most common sinonasal sites of metastasis include the maxillary sinuses (36%), ethmoid sinuses (25%), frontal and sphenoid sinuses (17%), and the nasal cavity (11%).…”

“… 8 , 9 The most common path via which RCC cells spread to the sinonasal region includes that via the inferior vena cava–heart–maxillary artery as well as via the avalvular vertebral venous plexus and the intracranial venous plexus. 9 The most common sinonasal sites of metastasis include the maxillary sinuses (36%), ethmoid sinuses (25%), frontal and sphenoid sinuses (17%), and the nasal cavity (11%). 9 Of note, in our index case, metastasis of RCC to the ethmoid sinus was seen (and surgically resected) prior to the detection of RCC metastasis to the uvula.…”

“… 9 The most common sinonasal sites of metastasis include the maxillary sinuses (36%), ethmoid sinuses (25%), frontal and sphenoid sinuses (17%), and the nasal cavity (11%). 9 Of note, in our index case, metastasis of RCC to the ethmoid sinus was seen (and surgically resected) prior to the detection of RCC metastasis to the uvula. There have also been multiple documented cases and literature reviews of RCC metastasis to the tongue.…”

Interleukin-8 and laryngeal squamous cell carcinoma

“…The mechanisms of cancer origin, invasion, and metastasis in head and neck cancer, especially in LSCC. Tumor, lymph the estimation of tumor aggressiveness; moreover, different conclusions may result from a heterogeneous group of investigated HNSCC cancers in different locations such as oral cancers, laryngopharyngeal carcinomas, nasal cavities and paranasal sinuses tumors (1,4,(22)(23)(24)(65)(66)(67)(68).. Biomarkers such as IL-8 deserve further investigation as they could have a role as a screening test for head and neck cancer. To date, there is little and still contrasting evidence on the role of IL-8 in LSCC; however, preliminary data available in the literature are encouraging and could suggest a role for IL-8 as a support of the clinical decisions for appropriate therapy and postoperative care in individual patients affected by laryngeal cancer.…”

Multiple metastases of clear-cell renal cell carcinoma to different region of the nasal cavity and paranasal sinus 3 times successively

“…[ 3 ] The most common sites are the lungs (76%), local lymph nodes (66%), bone (42%), and liver (41%). [ 3 ] Additionally, 15% of metastases occur in the head and neck, [ 4 ] with approximately 1% transferring to the head and neck in the absence of other metastases, [ 2 ] and rare cases involve transfer to the nasal cavity and paranasal sinus. This report presents one case of ccRCC that metastasized 3 times to the nasal cavity and paranasal sinus after nephrectomy.…”