Occult renal cell carcinoma manifesting with epistaxis in a woman: a case report

Abstract

IntroductionMetastatic disease in the sinonasal region occurs rarely and the primary site may be elusive. This case highlights the possibility of an occult renal tumor manifesting with nasal symptoms and the risk of severe bleeding following nasal biopsy.Case presentationWe report the case of a 79-year-old Caucasian woman who presented with a six-week history of intermittent left-sided nosebleeds. She was fit, without previous surgery or anticoagulation. Nasal endoscopy and computed tomography showed a hemorrhagic mass occupying her left ethmoid cells and middle meatus. After a highly hemorrhagic biopsy, the lesion was histologically confirmed as clear cell carcinoma. Screening revealed a right kidney mass with widespread metastases. Palliative radiotherapy to the sinonasal metastasis and systemic treatment rendered her free of symptoms nine months after initial presentation.ConclusionsGeneral practitioners and ear, nose and throat (ENT) doctors are very often confronted with epistaxis. A small minority of patients with epistaxis show a primary or metastatic nasal mass. Detection of the origin of secondary sinonasal masses requires a high index of suspicion and examination of infraclavicular sites by a multidisciplinary team. Renal cell carcinoma metastases are prone to severe bleeding during any surgical intervention, therefore, preoperative embolization is recommended. Resection or radiotherapy to the sinonasal metastasis of renal origin is justified in order to prevent recurrent nosebleeds.

Metastases to nasal cavity and paranasal sinuses

“…RCC can metastasize early, and symptoms of a metastatic tumor may be the first clinical presentation . Alternatively, sinonasal RCC metastases may occur many years (up to 18) after treatment of the primary tumor .…”

ecancermedicalscience

“…Bernstein et al, reported that a breast malignancy was the third most common cause for metastasis to the paranasal sinuses; the most common source is a renal primary. This has been confirmed in subsequent reviews of the literature [4, 6]. …”

“…Metastases to the ethmoid sinuses are rarer still, with only three documented cases from a breast primary [3, 4]. The most common site within the paranasal sinuses for breast cancer metastases is the maxilla/maxillary antrum [3, 5].…”

“…In most of the reports in the literature, the patient has a mass lesion within the sinuses on examination at the time of presentation [4, 5, 7]. Also, the bone scan findings were non-specific, as there is a variable degree of uptake in sinusitis as well as metastases.…”

Breast Cancer with Metastasis to the Nasopharynx and Paranasal Sinuses

“…Thus, possibility of a primary or secondary maxillary tumor must be considered in case of ineffective sinus infection treatment (7)(8)(9)(10).…”