CASE REPORT
A CASE OF RENAL CELL CARCINOMA WITH METASTASIS TO
SPHENOID SINUS
Chaitanya Pentapati1, Sreenivas V2, Rose Reynold3, Ophelia D’Souza4
HOW TO CITE THIS ARTICLE:
Sreenivas V, ChaitanyaPentapati, Rose Reynold, Ophelia D’Souza. “A Case of Renal Cell Carcinoma with
Metastasis to Sphenoid Sinus”.Journal of Evidence Based Medicine and Healthcare; Volume 1, Issue 7,
September2014; Page: 725-729.
ABSTRACT: Renal cell carcinoma is a relativelyrare tumor representing approximately 3% of
malignant tomor.2 About a third of patients with renal cell carcinoma have metastasis at
diagnosis.2 Clear cell carcinoma is a relatively rare tumor representing approx. 85% of renal cell
carcinoma, but has a characteristic of early metastatic.2Metastatic tumors in the Para nasal
sinuses are very rare.2 Metastasis to sphenoid sinus is an extremely rare event with less than 10
documented cases reported in English literature.6 We report a case of renal cell carcinoma with
metastasis to sphenoid sinus. Renal cell carcinoma is a rare tumor representing approx. 3% of all
tumors. About 1/3 rd. of all patients present with metastasis.
INTRODUCTION: The clear cell carcinoma is a rare tumor with incidence of 9.6/100000
population with peak incidence in 6th decade.2 About 30% of patients have metastasis at
diagnosis and 40 to 50% will develop metastasis afterinitial diagnosis.2 The renal cell carcinoma is
characterized by early metastatic spread and poor survival due to poor response to radiation and
chemotherapy. The organs most often affected by metastasis are lungs, retroperitoneal lymph
nodes, bone, kidney, contra lateral adrenal gland, brain, head and neck in decreasing order of
frequency. The tumor which most commonly metastasizes to par nasal sinuses is renal cell
carcinoma.2Symptoms are unspecific, but theepistaxis corresponds the most common sign due to
the high vascularization’s of tumor.6 Prognosis is uncertain.The survival rate fluctuates between
15%-30% at 5 years.4Because of this rarity,the literature shows few reports of this entity.6
CASE REPORT: A 59 year old male patient was referred to department of ENT, Head & Neck
Surgery from a reputed neurological center with symptoms of epistaxis, reduced vision in left eye
and diplopia since 3 months. Patient underwent left radical nephrectomy for renal cell carcinoma
(clear cell variant) 4years back.
Routine blood investigations including total blood count, urea and electrolytes, LFT and
chest x-ray were normal.
Contrast CT of Para nasal sinuses showed heterogeneously enhancing mass in left
sphenoid sinus with the destruction of left bony orbital wall(Figure 1). Diagnostic Nasal
endoscopy and biopsy was done under General Anesthesia (Figure 2, 3).Biopsy came as clear cell
carcinoma (which metastasized from renal carcinoma).Patient was referred back to neurology
center for embolization followed by resection.
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CASE REPORT
FIGURE 1
FIGURE 2
FIGURE 3
DISCUSSION:Primary tumors of PNS are very rare constituting 5% of all head and neck
tumors.4 Metastatic tumors of PNS are even rare comprising 0.25 to 5% of all PNS tumors.4
Kidney (renal cell carcinoma), lung, breast, testis (seminoma), gastrointestinal tract, and thyroid
gland are, in order of frequency, the most common locations of the primary tumors that give
origin to these metastases.5 The maxillary sinuses are most commonly affected by metastatic
tumors to the sinonasal region, followed in frequency the ethmoid sinus, frontal and sphenoid.6
Epistaxis is the most common symptom due to highly vascular nature of renal cell
carcinoma. Cranial nerve palsies involving (II, III, IV & VI) is common in sphenoid metastasis.2
Route of spread:It occurs due to the presence of valve less intercommunicating vertebral veins
allowing intra-abdominal metastasis to bypass heart and lungs and communicate directly with
veins of head and neck (pterygoid plexus, cavernous sinus, superior part of pharyngeal plexus).6
Patients with distant metastasis from renal cell carcinoma have poor survival 5-7% at 5
years. (With isolated metastasis it increases to 25% at 5 years).4
As the tumor is chemo and radio resistant resection is best treatment wherever feasible.
Unresectable tumors can be treated with chemotherapy (vinblastine, 5FU,
flourodeoxyuridine), immunotherapy, cellular therapy or hormonal therapy.2
CONCLUSION: This review highlights the rarity of the case and the importance in the
differential diagnosis of sinus disease6
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CASE REPORT
REFERENCES:
1. FischettiG, CuzariS, LeoneP, De MartinoP, MusyM, MarianeS, FraioliA. and ValentiniM.
A.“Immunotherapy in the Management of Metastatic Renal Carcinoma”, Minerva Urologica e
Nefrologica, Vol. 54, No. 2, 2002, pp. 113-117.
2. KoutnouyanH. A, RumoreG. J. and KahnJ. M.“Skull Metastasis from Renal Cell Carcinoma.
Case Report and Literature Review,” Annals of Otology, Rhinology and Laryngology, 1998;
107(7): pp. 598-602.
3. Flocks R. H. and BoatmanD. L.“Incidence of head and neck metastases from genito urinary
neoplasms,” Laryngoscope, 83(9):pp. 1527–1539, 1973.
4. PatelM, ThinakkalR, SoboroffB, and BorkenhagenR.“Renal metastatic epistaxis: case report
and update of literature, 1966–1978,” Illinois Medical Journal, 158(5): pp. 335–339, 1980.
5. SalehH. A, O'FlynnP, and N. S. Jones.“Prostatic metastases in the nose and paranasal
sinuses,” Journal of Laryngology and Otology, 107(7):pp. 629–632, 1993.
6. PeterssonF, HuiT. S, LokeD, and PuttiT. C.“Metastasis of occult prostatic carcinoma to the
sphenoid sinus: report of a rare case and a review of the literature,” Head and Neck
Pathology, 6(2): pp. 258–263, 2012.
AUTHORS:
1. ChaitanyaPentapati
2. Sreenivas V.
3. Rose Reynold
4. Ophelia D’Souza
PARTICULARS OF CONTRIBUTORS:
1. Senior Resident, Department of ENT, Head
& Neck Surgery, St. John’s Medical College
Hospital.
2. Professor, Department of ENT, Head & Neck
Surgery, St. John’s Medical College Hospital.
3. Junior Resident, Department of ENT, Head &
Neck Surgery, St. John’s Medical College
Hospital.
4. Professor, Department of ENT, Head & Neck
Surgery, St. John’s Medical College Hospital.
NAME ADDRESS EMAIL ID OF THE
CORRESPONDING AUTHOR:
Dr. Chaitanya P,
H. No. 845, 20th B Main,
Koramangala 8th Block,
Bangalore.
E-mail: chaituamc@gmail.com
Date
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Submission: 01/09/2014.
Peer Review: 02/09/2014.
Acceptance: 03/09/2014.
Publishing: 10/09/2014.
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