Sinonasal Renal Cell-Like Carcinoma: Case Report and Review of the Literature

Abstract

recent WHO classification of primary sinonasal malignancies contains 44 distinct histopathologic entities [3]. Understandably, these cancers present a formidable challenge for both the surgeon and pathologist.In this article we present an unusual case of clear cell neoplasia of the paranasal sinuses found to be consistent with sinonasal renal cell-like adenocarcinoma (SNRCLA). The finding of clear cell neoplasia in a sinonasal specimen is rare but associated with a surprisingly wide differential diagnosis. When evaluating the differential diagnosis for a clear cell neoplasm of the sinonasal tract, an underlying renal cell carcinoma (RCC) must first be ruled out. RCC is the most common metastatic lesion to the nasal cavity and paranasal sinuses [4] and approximately 6-15% of patients with RCC will have metastatic deposits in the head and neck [5,6]. In addition to metastatic RCC, other diagnostic considerations for clear cell neoplasia in the paranasal sinuses include a clear cell variant of squamous cell carcinoma, melanoma, primary salivary clear cell carcinoma, metastatic clear cell thyroid carcinoma, clear cell predominant mucoepidermoid carcinoma, and SNRCLA. Case ReportAn 80 year old female presented to our otolaryngology clinic with an asymptomatic right sinonasal mass. She reported a history of left sided acinic cell carcinoma treated at an outside institution with endonasal resection and adjuvant radiotherapy approximately eight years prior. Diagnostic nasal endoscopy revealed a large friable soft tissue mass arising from the lateral nasal wall near the axilla of the right middle turbinate. Imaging revealed a 3 cm tumor centered at the right nasolacrimal sac with extension superiorly to involve the nasal septum and dura of the anterior Abstract The differential diagnosis for clear cell neoplasms of the sinonasal tract is wide but critical to understand. In this paper, we describe a case of renal cell-like adenocarcinoma (SNRCLA) presenting as a paranasal sinus mass with clear cell morphology. The relevant literature is reviewed and the workup for clear cell neoplasms described. SNRCLA is a rarely encountered low grade glandular malignancy of the paranasal sinuses. Despite its morphologic mimicry of renal cell carcinoma, SNRCLA demonstrates a seromucinous phenotype and is associated with a favorable prognosis and low recurrence rates after surgical resection.

An update on head and neck cancer: new entities and their histopathology, molecular background, treatment, and outcome

“…Sinonasal renal cell‐like adenocarcinoma (SRCLA) is constituted by clear and eosinophilic cells in a glandular or solid architecture and has a striking overlap with metastatic renal cell carcinoma. Immunohistochemically, SRCLA is positive for S100, SOX‐10, DOG‐1, and CA‐IX and is therefore possibly a clear cell variant of a low‐grade non‐intestinal type adenocarcinoma although this is a topic of discussion . Metastatic renal cell carcinoma is excluded by negativity for PAX8 and RCC .…”

“…Biphenotypic sinonasal sarcoma is a strictly localized disease with local recurrences in one‐third of cases and only two fatal cases reported . Only few cases of SRCLA and ETV6‐rearranged low‐grade SNAC have been reported, but the prognosis seems favorable with only rare local recurrences and no distant metastases or cases with fatal outcome reported to date .…”

“…Biphenotypic sinonasal sarcoma is a strictly localized disease with local recurrences in one-third of cases and only two fatal cases reported (84,95,(105)(106)(107). Only few cases of SRCLA and ETV6-rearranged low-grade SNAC have been reported, but the prognosis seems favorable with only rare local recurrences and no distant metastases or cases with fatal outcome reported to date (80,82). Primary surgery is preferred whenever possible for securing free margins and precise definition of tumor extension, which is important for adjuvant RT.…”

Sinonasal renal cell-like adenocarcinoma

“…Учитывая редкость и трудность диагностики СПКПА, данных об эпидемиологии недостаточно. Со времени ее первого описания насчитывается только 20 случаев СПКПА [3][4][5][6][8][9][10][11][12][13][14][15]. СПКПА -редкая опухоль, в основном встречается у пациентов в возрасте от 22 до 75 лет (в среднем -54 года), чаще у женщин [3][4][5].…”

“…В литературе не описаны случаи ее метастазирования. В СПКПA определяется экспрессия CK7; в большинстве случаев реакция с антителами к Vimentin негативная [10].…”