Renal Cell Carcinoma Metastatic to the Sinonasal Cavity: A Review and Report of 8 Cases

Abstract

Renal cell carcinoma (RCC) metastatic in the sinonasal cavity is rare. In many cases, it represents the initial presentation of RCC. We conducted a retrospective chart review to report the clinical presentation, imaging, and treatment of RCC metastases in the sinonasal cavity at two tertiary care referral centers. Our population was made up of 8 patients—6 men and 2 women, aged 55 to 86 years (mean: 66.9; median: 63.5)—who had been diagnosed with cancer in the sinonasal cavity. The most common complaints were epistaxis, nasal obstruction, and diplopia. Cancers were located in the ethmoid sinus (n = 3), nasal cavity (n = 2), sphenoid sinus (n = 2), and maxillary sinus (n = 1). Local treatment involved resection and adjuvant radiotherapy in 4 patients, surgery alone in 2 patients, and radiotherapy alone in the other 2. The lesion was embolized before surgery in 4 cases. We also performed a critical review of similar published cases. Our literature review covered 53 cases of RCC metastatic to the sinonasal cavity, including ours. Metastases were the first presentation of RCC in 24 of these cases (45.3%); in our series, the metastases led to the diagnosis of the primary RCC in 3 cases (37.5%). In the 53 reported cases, metastatic resection was performed on 35 patients (66.0%). Survival data were available for 22 of these operated patients, and 17 of them achieved a complete local response. Adjunctive radiotherapy was not associated with a better local response. Overall survival was significantly better in patients who had an isolated metastasis rather than multiple metastases (p = 0.013). There was no difference in overall survival between patients whose metastasis represented the initial presentation of RCC and those whose metastasis did not (p = 0.95). We recommend that sinonasal metastasis be suspected in the event of unilateral nasal bleeding or nasal obstruction in patients diagnosed with RCC. Embolization may prevent abundant bleeding during removal. Surgery may improve the quality of life of these patients while decreasing nasal obstruction and bleeding.

Recurrent epistaxis as manifestation of renal cell carcinoma sinonasal metastasis

“…Therefore, the caval route could be responsible for the concurrent lung or brain metastases, and the retrograde venous route could Today, RCC is often asymptomatic and is generally detected incidentally. One third of newly diagnosed RCC patients have a distant metastasis as the initial presentation; another third of RCC patients develop a metastasis during the follow-up [4]. In our case, the patient underwent curative nephrectomy three years before the appearance of recurrent nasal bleeding and had been disease-free during the regular follow-up.…”

Embolization of an Exophytic Posterior Neck Mass Secondary to a Cutaneous Renal Cell Carcinoma Metastasis

“…Given the spontaneous episodes of hemorrhage and significant vascularity, our surgical colleagues requested preoperative tumor embolization. A similar treatment strategy has been performed in patients with RCC metastasis to the sinonasal cavity, especially if computed tomography or MRI demonstrates a highly vascularized tumor or in cases of spontaneous bleeding, both of which were present in our case [ 16 , 17 ]. Preoperative embolization has been shown to provide better visibility for the surgeon, shorten operative time, reduce intraoperative blood loss while assisting tumor resection [ 16 , 17 ].…”

“…A similar treatment strategy has been performed in patients with RCC metastasis to the sinonasal cavity, especially if computed tomography or MRI demonstrates a highly vascularized tumor or in cases of spontaneous bleeding, both of which were present in our case [ 16 , 17 ]. Preoperative embolization has been shown to provide better visibility for the surgeon, shorten operative time, reduce intraoperative blood loss while assisting tumor resection [ 16 , 17 ]. Additionally, preoperative embolization has also been shown to reduce intraoperative blood loss in the treatment of vascular cervical spine tumors and osseous metastasis [ 2 , 18 ].…”

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

“…5 Renal cell carcinomas are known to metastasize early, and symptoms due to the metastatic lesion may be the initial and only manifestation. 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.…”

“…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.…”