Metastatic Renal Cell Carcinoma Mimicking Trigeminal Schwannoma in a Patient Presenting with Trigeminal Neuralgia

Abstract

We present an unusual case of a metastatic renal cell carcinoma (RCC) mimicking trigeminal schwannoma. The patient, with no prior history of RCC, presented with clinical symptoms and imaging consistent with trigeminal neuralgia secondary to trigeminal schwannoma. Magnetic resonance imaging of the brain showed a large bilobed cystic/solid mass primarily in the cerebellopontine angle cistern, with extension into the left middle cranial fossa, Meckel cave, and left cavernous sinus. Following surgical excision, histopathology revealed the tumor to be an RCC infiltrating into the trigeminal nerve fascicles. Further imaging and investigation revealed widespread metastasis to the vertebral bodies and long bones. Metastatic RCC to the trigeminal nerve is rare. Despite the development of more effective treatment modalities, the prognosis of metastatic RCC remains poor. To our knowledge, this is the first reported case of RCC metastasizing to the trigeminal nerve fascicles.

Renal Cell Carcinoma Metastasis to Meckel’s Cave Treated With Repeat Stereotactic Radiosurgery: A Case Report and Review of the Literature

“…To the best of our knowledge, no previous report has described a metastasis to MC that has been treated with radiosurgery on two occasions. RCC metastases to MC are a rare occurrence, with only four documented cases in the literature, each presenting with facial pain or hypoesthesia [1,2,4]. There is only one report of SRS without resection for metastatic disease from any primary site to MC, in a case of castration-resistant prostate cancer.…”

“…Treatment options for metastatic disease to MC include surgical resection, radiotherapy or SRS and/or systemic therapy [1,4]. Surgical resection of tumours affecting MC are often not feasible and/or associated with significant morbidity, contributing to the decision in this case to avoid surgery.…”

“…Metastases directly to MC are rare [1]; metastases invading from adjacent cavernous sinus are also possible but uncommon. To the best of our knowledge, there are three case reports describing four cases of RCC metastases to MC and each managed in different ways [1,2,4]. We hereby report a case of RCC metastasis to MC treated with repeat SRS, and review the literature for treatment recommendations and reported data applicable to this rare clinical situation.…”

Unusual Spread of Renal Cell Carcinoma to the Clivus with Cranial Nerve Deficit

“…Radiological investigations such as CT scan and MRI are useful. CT scan assesses the degree of bone damage or calcification while MRI assesses the structures in the posterior fossa [ 18 , 20 ]. Treatment varies based on symptoms and locations of the mass, or the histology of the primary cancer; it is either by radiotherapy which is the standard, resection of the mass endoscopically if the tumor is operable, or chemotherapy or both radiotherapy and chemotherapy [ 1 – 5 , 10 , 17 , 19 ].…”