Metastatic renal cell carcinoma to the sinonasal cavity: a case series

Abstract

Objectives To describe the presentation, work-up, and management of patients with metastatic renal cell carcinoma (RCC) to the sinonasal cavity and skull base, and to describe our current treatment algorithm of endoscopic surgical resection followed by radiation therapy. Design Retrospective review of two recent cases from our institution over a 1-year period, with a relevant review of the literature. Setting A large regional tertiary care facility. Participants Consecutive cases of RCC with metastases to the sinonasal cavity presenting to our institution. Main Outcome Measures Preoperative and postoperative sinonasal outcome test (SNOT)-22 scores, duration of hospital stay, complications, and local disease control Results Patients in this series underwent preoperative embolization followed by endoscopic resection without complication. Postoperatively they were treated with radiation therapy. They experienced improvement in their SNOT-22 scores and are currently free of local disease. Conclusion Metastatic RCC to the sinonasal cavity can be safely treated with preoperative embolization followed by endoscopic surgical resection and radiation therapy, which can result in improvement in sinonasal quality of life and is a potential adjunct for local control of disease.

Keywords: embolization; epistaxis; nasal obstruction; quality of life; renal cell carcinoma.

Fig. 1

(A) Noncontrast coronal computed tomography scan demonstrating soft tissue mass extending to the cribriform plate and skull base. (B) 18-month postoperative T1 postcontrast magnetic resonance imaging demonstrating patent left maxillary antrostomy and no evidence of recurrent disease.

Fig. 2

Sagittal angiogram of the left internal carotid demonstrating significant anterior ethmoid artery contribution to the lesion.

Fig. 3

(A) Sagittal angiogram of the left external carotid showing sphenopalatine contribution. (B) Postembolization of the left sphenopalatine artery.

Fig. 4

(A) A 1000× hematoxylin and eosin stain showing typical clear cells arranged in nests with pooling of red blood cells. (B) Renal cell carcinoma antigen confirms the diagnosis with apical cytoplasmic staining.

Fig. 5

(A) Axial T1 postcontrast image showing an enhancing lobulated mass centered in the posterior ethmoid air cells, extending into the sphenoid and to the clivus. (B) Axial computed tomography without contrast showing bony erosion of the right clivus.

Fig. 6

(A) Right external carotid angiogram showing dense vascular contribution from the internal maxillary artery. (B) Following embolization of the internal maxillary artery.