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

Abstract

Rationale:Distant metastasis of clear-cell renal cell carcinoma (ccRCC) to the nasal cavity and paranasal sinus is rare. Endoscopic biopsy used to be performed for diagnosis when it is difficult for complete resection due to intense bleeding during surgery. According to previous literature, the outcomes of metastasis after endoscopic surgery remain unclear.Patient concerns:A 62-year-old man with a history of epistaxis was referred to our institution. The clinical, computed tomography (CT) and magnetic resonance imaging (MRI) examination indicate metastasis to sinonasal sinuses.Diagnoses: He was histopathologically diagnosed with different anatomical structures of nasal cavity and paranasal sinus metastases 6, 14, and 15 years after the initial nephrectomy for ccRCC.Interventions:He underwent endoscopic surgery 3 times, once at the time of each metastasis.Outcomes:He survived for 20 years despite of multitransfers and died due to multiple organ failure.Lessons:Metastasis of ccRCC to the nasal cavity and paranasal sinus is characterized by varied growth rates, metastatic times and spreading patterns; ccRCC metastasis should be considered with the presence of hemorrhagic lesions in the nasal cavity and paranasal sinus. Endoscopic surgery is the first-line treatment.

Metastatic Renal Cell Carcinoma to the Left Sphenoid Sinus: A Case Report in Light of the Literature

“…6 Because of initial slow growth in about 60% of cases of renal cell carcinoma, the primary lesion receives little attention until symptoms occur because of metastasis. 1,[3][4][5][6] There are two routes for renal cancer to metastasize to the nasal and paranasal sinuses. The first route is the caval route, in which tumor cells travel through the inferior vena cava, the right heart, the lungs, the left heart and the maxillary artery to the nasal and paranasal sinuses.…”

“…Many metastatic tumors originating from renal cancer develop in multiples, but most metastatic tumors in the nasal or paranasal sinuses are single and are treated surgically. [1][2][3][4][5][6][7] In this case, CT and MRI indicated no evidence of intracranial extension or bony defect of the skull base, and complete resection by endoscopy was performed. However, endoscopic surgery for tumor(s) in sphenoid sinus is still challenging because of the narrow working space, the angled, anatomically variable sphenoid sinus and the proximity to the optic canal, internal carotid artery and skull base.…”

“…Twenty-five percent of patients with renal cell carcinoma have already distant metastatic lesions at the time of initial diagnosis. 1 Regional lymph nodes, lungs, bones and liver are common metastatic sites, but metastasis in the head and neck region is rare. 2,3 On the other hand, renal cell carcinoma is the most frequent tumor to metastasize to the nasal cavity and paranasal sinuses among infraclavicular tumors.…”

Granulomatous Lesion in Inserted Gum-Metastasis of Renal Clear Cell Carcinoma. Case Presentation

“…Así mismo el carcinoma de células renales es la tercera neoplasia más frecuente en metastatizar en la región de la cabeza y cuello, precedida del carcinoma de mama y pulmón (7,16,(24)(25)(26)(27)(28)(29).…”

“…En la región de cabeza y cuello las metástasis de carcinoma de células renales se localizan con mayor frecuencia en cavidad nasal y senos paranasales, seguidos de la cavidad oral, siendo la encía adherida y lengua los sitios más comunes a pesar de ser infrecuentes (24,25,29,30). Además, el pronóstico de los pacientes con metástasis en cavidad oral es pobre y el tratamiento habitualmente es paliativo para mejorar la calidad de vida y prevenir complicaciones (16).…”