The Sphenoid Sinus—A Site for Metastasis

Abstract

While metastatic tumors to the nose and the paranasal sinuses overall are unusual, metastasis to the sphenoid sinus is exceedingly rare. Presented are 26 cases of metastasis to the sphenoid sinus. Seven were treated at UCLA between 1955 and 1988, and 19 additional cases were discovered from a search of the medical literature. The patients ranged from 14 months to 79 years of age. The most common tumor sites from which sphenoid metastases arose were the prostate and the lung. In 11 of the 26 cases, the sphenoid sinus metastasis was the first presentation of malignancy. Patients manifested signs and symptoms that were indistinguishable from those from primary tumors of the sinus. They included headache, facial pain, visual changes, and single or multiple cranial neuropathies. While cure of patients with sphenoid metastasis has not been reported, significant palliation with resolution of morbidity is possible in many patients with radiation therapy. Although metastasis to the sphenoid sinus is an uncommon entity, when present, signs and symptoms relating to this metastasis are frequently the first presentation of disease. As such, patients with sphenoid sinus symptoms suggestive of sphenoid sinus malignancy should be vigorously evaluated for the possibility of primary as well as metastatic tumor of the sinus.

Evaluation and Surgical Management of Isolated Sphenoid Sinus Disease

“…Metastatic disease has been reported to involve the sphenoid sinus, with prostate, renal, and lung cancers predominating. 13,14 The use of MR imaging is helpful in the preoperative evaluation of these lesions, both in terms of providing information about the possible abnormality and to determine the relationship to surrounding vital structures. Furthermore, MR imaging is superior to CT in differentiating tumor from obstructed secretions.…”

Sphenoid sinus involvement in neuroblastoma: a case report and review of the literature

“…It was reported that 7% of metastatic paranasal sinus tumors involved the sphenoid sinus [6]. Mickel and Zimmerman [7] reviewed 26 cases with metastatic tumors of sphenoid sinuses ranged from 14 months to 79 years of age. The most common primary tumor sites were prostate and lung and only one of them was neuroblastoma.…”

Diplopia – An Unusual Primary Manifestation of Metastatic Renal Cell Carcinoma

“…Other primary sources for secondaries in the PNS that should be borne in mind include prostate, lung and thyroid adenocarcinomas [2]. RCC is known to be one of the commonest [5] potential primary tumors displaying metastases in this location [1,[4][5][6]. The present case serves to alert the treating surgeon to the occurrence of such symptoms secondary to the spread of asymptomatic primary lesions elsewhere in the body.…”

“…The PNS tend to be implicated whenever visual abnormalities are detected, and when present these related ocular signs are frequently the sentinel symptoms [3]. Thus, patients with such symptoms ought to be vigorously evaluated for the possibility of PNS [4] tumors.…”

“…While cure of patients with sphenoid metastasis has not been reported, significant palliation with resolution of morbidity is possible in many patients with radiation therapy [4]. Nevertheless, for the patient to have any chance of potential cure, the tumor must be diagnosed at the earliest possible time.…”