Renal cell carcinoma presenting as epistaxis from a nasal cavity metastasis

Abstract

We present a 58-year-old gentleman who initially presented to the otolaryngology clinic with new onset epistaxis revealing a palpable facial mass that was subsequently biopsied revealing metastatic renal cell carcinoma. We hope to present an interesting case highlighting the rarity of this disease and unusual presentation in which the presence of the primary renal cell carcinoma was recognized only after biopsy.

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.…”

“…Non-surgical treatment modalities such as chemotherapy, immunotherapy and radiotherapy have significantly failed to improve overall survival, and surgery is the mainstay of treatment and offers the best hope for survival. [1][2][3][4] Recently, kinase inhibitors, including sorafenib, sunitinib and temsirolimus, were used in patients with metastatic renal cell carcinoma. 1,3,6,7 In conclusion, although metastatic renal cell carcinoma to the sphenoid sinus is rare, it might be considered in the differential diagnosis of masses in the paranasal sinus even long after initial treatment of renal cancer.…”

“…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. 4 We report a rare case of a 79-year-old Japanese woman with metastasis of renal cell carcinoma to the left sphenoid sinus, 15 years after nephrectomy for primary renal cell carcinoma.…”