Petruzzelli GJ1*, Shook T2, Campbell WJ3 and Gupta S4
1Anderson Cancer Institute, Memorial Health-Savannah, USA
2Urological Associates of Savannah, USA
3The Georgia Institute for Plastic Surgery, USA
4Mercer University School of Medicine, USA
Metastasis of Renal Cell Carcinoma (RCC) to the paranasal sinuses is extremely rare, with approximately 100 cases reported in the literature. We report the case of a 60-year-old man with a history of clear cell RCC, who presented 30 months after nephrectomy for his primary tumor. His symptoms included right-sided facial asymmetry, severe facial pain, and right-sided nasal airway obstruction. CT and gadolinium enhanced magnetic resonance images showed opacification of the right maxillary sinus with a large sinus mass filling the antrum with destruction of the horizontal process of the maxilla and invasion of the alveolar ridge (Figure 1). The tumor was biopsied through a transantral approach and histological examination was consistent with clear cell RCC. There were no additional metastases present upon investigation with CT of the chest, abdomen, and pelvis. The patient underwent a standard right globe sparing radical maxillectomy and reconstruction with an anterior-lateral thigh microvascular free tissue transfer. Pre-operatively, the tumor was embolized in an effort to reduce intraoperative blood loss. Final histopathology confirmed metastatic renal cell carcinoma-clear cell variety with negative surgical margins. Although rare, metastatic renal cell carcinoma must always be considered during evaluation of new sinonasal lesions, with or without a prior history of nephrectomy, especially if systemic signs such as hematuria or suspicious CT findings such as bone erosion are present. Epistaxis and nasal obstruction are the most common presenting signs but several atypical presentations have been reported. A correct diagnosis requires a thorough clinical history, radiological evaluation, and biopsy with consideration of propensity for bleeding during both biopsy and surgery. Prompt evaluation and treatment of metastatic RCC can considerably improve quality of life and survival in select patients.
Petruzzelli GJ, Shook T, Campbell WJ, Gupta S. Paranasal Sinus Metastases of Renal Cell Carcinoma: A Case Report and Comprehensive Literature Review. Ann Clin Case Rep. 2019; 4: 1642.