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

Abstract

Renal cell carcinoma (RCC) has unusual presentation affecting elderly males with a smoking history. The incidence of RCC varies while the incidence of spread of RCC to the clivus is rare. The typicality of RCC presentation includes hematuria, flank pain, and a palpable flank mass; however, RCC can also present with clival metastasis. The unique path of the abducens nerve in the clivus makes it susceptible to damage in metastasis. We report a case of a 54-year-old African American female that was evaluated for back pain, weakness, numbness, and tingling of bilateral lower extremities and subsequently disconjugate gaze and diplopia. Brain MRI confirmed metastasis to the clivus. She was started on radiotherapy and was planned for chemotherapy and transfer to a nursing home. When a patient presents with sudden unusual cranial nerve pathology, the possibility of metastatic RCC should be sought.

Clival metastasis of renal clear cell carcinoma: Case report and literature review

“…Most reports of metastases to the clivus have been in the form of case reports, case images, or small series[ 9 ]. We performed an extensive review of available reports on clival metastases from RCCC and identified nine patients, including the present case (Table 1 ).…”

“…The clivus, part of the skull base, is located between the foramen magnum and dorsum sellae and lies deep in the midline in intimate relationship with various critical neurovascular structures[ 9 , 11 ]. In particular, the sixth nerve is very prone to involvement by tumors growing from the clivus and petroclival regions because of its long serpentine course from the brainstem to the superior orbital fissure[ 12 ].…”

Symptom Outcomes of Cancer Patients With Clival Metastases Treated With Radiotherapy: A Study of 44 Patients

“…Clival metastases originate most frequently from prostate, kidney, and liver cancers (4). Other primary tumors from which clival metastasis can spread include breast cancer, melanoma skin, tonsillar, lung, gastrointestinal, and blood cancers (8,9). Prostate cancer is the most common cancer type associated with clival metastasis, often accompanied by multiple cranial nerve deficits (3,6).…”