Metastasis to Paranasal Sinuses as the First Presenting Sign of Renal Cell Carcinoma

Abstract

The clear cell carcinoma is a relatively rare tumor, represented approximately 85% by renal cell carcinoma (RCC), but has a characteristic of early metastatic, which sometimes spread to unusual places. Metastatic tumors in the paranasal sinuses are very rare. This case report a 65 years-old patient who presented sinusitis and epitaxis as a first sign of renal cell carcinoma with metastasis to the right maxillary sinus, which was opereted at Lagoa Hospital-RJ and strengthen the inclusion of this disease in the differential diagnosis of sinus disease. The renal cell carcinoma is a relatively rare tumor, representing approximately 3% of malignant tumors. About a third of patients with renal cell carcinoma have metastasis at diagnosis. The sinuses are a rare location of metastasis. The maxillary sinuses and the paranasal sinuses are most commonly affected by metastatic tumors to the sinuses region. The most frequent primary tumor to metastasis to paranasal sinuses is the renal cell carcinoma. This report highlights the rarity of the case and the importance in the differential diagnosis of sinus disease.

Renal cell carcinoma presenting as epistaxis from a nasal cavity metastasis

“…RCC comprises approximately 3% of all primary malignancies, while primary sinonasal neoplasms compromise <1% of all malignancies [1] , [2] , [3] , [4] . The most common sites of metastasis of RCC are in the lung at 74%, liver at 41%, and bone at 42% [1] , [4] , [5] , [6] . Although not as common, RCC has been reported to metastasize to the head and neck.…”

“…RCC is classically known to metastasize to unusual locations with a median time of 15 months after nephrectomy. Literature reviews of 46 cases of metastatic tumors to the head and neck region, 4 of which were located in the nasal and/or paranasal sinuses and 1 in the maxillary sinus [2] , [3] , [4] .…”

“…The differential diagnosis for masses in this region includes angiofibroma, inverted papilloma, squamous cell carcinoma, adenocarcinoma, or metastasis. Malignant features include tumor expansion, erosion, remodeling, expansion of the sphenopalatine foramen, and pterygopalatine fossa [1] , [3] , [4] , [5] , [6] , [7] . Olfactory neuroblastomas arise from neuroepithelial cells of the olfactory mucosa with possibility for lymph node metastasis and distant metastasis.…”

“…Characteristic findings in metastatic RCC include avid enhancement without calcification due to high tumor vascularity. Intralesional calcifications are more often seen in adenocarcinoma, olfactory neuroblastoma, inverted papilloma, fibrous dysplasia, osteomas, osteosarcomas, and cartilaginous tumors [1] , [2] , [3] , [4] , [5] , [6] , [7] . Further, high-grade malignancies tend to show extensive bony destruction.…”

“…Renal cell carcinoma (RCC) is the most common primary tumor of the renal parenchyma and represents approximately 3% of all malignancies [1] , [2] , [3] , [4] . RCC is known to metastasize to unusual sites and has been reported to metastasize to the sinonasal region.…”