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Sinonasal Metastatic Renal Cell Carcinoma: A Report of Two Cases with Varied Presentation and a Review of Literature

  • Pooja Dalakoti
  • Kailesh PujaryEmail author
  • Balakrishnan Ramaswamy
Other Articles
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Abstract

Renal cell carcinoma is usually slow growing with delayed vague symptoms and may not be detected until an advanced stage. In only 9% of the cases the classical triad of “haematuria, costovertebral pain and abdominal mass” is seen. Less commonly, sinonasal metastasis may also be the presenting feature of RCC. So, in any case of sinonasal mass, possibility of metastasis from renal malignancy should be considered. Sinonasal metastasis from renal malignancy can occur even several years after the primary is treated with nephrectomy. In sinonasal region maxillary sinus is the most commonly affected. Isolated metastasis to the nose is extremely rare. Malignancies from various other sites of the body can also metastasize to sinonasal region. Epistaxis is the most common symptom. This is because of vascular stroma of the metastatic deposit. A 45 year old male with history of right nephrectomy 1 year back presented with intractable epistaxis. A 66 year old male presented with profuse epistaxis without any history of previous malignancies. Both the cases were evaluated resulting to the diagnosis of sinonasal metastasis from Renal Cell carcinoma. In the first case, metastasis occurred 1 year post surgery whereas in second case sinonasal metastasis was the presenting feature of Renal Cell carcinoma. Epistaxis is the most common symptom. This is because of vascular stroma of this metastatic deposit. In renal cancer, symptoms of metastasis often precede the symptoms of primary tumor.

Keywords

Renal cell carcinoma Intractable epistaxis Sinonasal metastasis Head and neck metastasis 

References

  1. 1.
    Nayak DR, Pujary K, Ramnani S, Shetty C, Parul P (2006) Metastatic renal cell carcinoma presenting with epistaxis. Indian J Otolaryngol Head Neck Surg 58(4):406–408CrossRefGoogle Scholar
  2. 2.
    Gottlieb MD, Roland JT (1998) Paradoxical spread of renal cell carcinoma to the head and neck. Laryngoscope 108(9):1301–1305CrossRefGoogle Scholar
  3. 3.
    International Agency for Research on Cancer. GLOBOCAN 2012: Kidney—estimated cancer incidence, mortality and prevalence worldwide. http://globocan.iarc.fr/Pages/fact_sheets_population.aspx. Accessed 28 May 2018
  4. 4.
    Abraham GP, Cherian T, Mahadevan P, Avinash TS, George D, Manuel E (2016) Detailed study of survival of patients with renal cell carcinoma in India. Indian J Cancer 53(4):572CrossRefGoogle Scholar
  5. 5.
    Nahum AM, Bailey BJ (1963) Malignant tumors metastatic to the paranasal sinuses: case report and review of the literature. Laryngoscope 73(7):942–953CrossRefGoogle Scholar
  6. 6.
    Simo R, Sykes AJ, Hargreaves SP, Axon PR, Birzgalis AR, Slevin NJ, Farrington WT (2000) Metastatic renal cell carcinoma to the nose and paranasal sinuses. Head Neck: J Sci Spec Head Neck 22(7):722–727CrossRefGoogle Scholar
  7. 7.
    McNichols DW, Segura JW, DeWeerd JH (1981) Renal cell carcinoma: long-term survival and late recurrence. J Urol 126(1):17–23CrossRefGoogle Scholar
  8. 8.
    Godley PA, Stinchcombe TE (1999) Renal cell carcinoma. Curr Opin Oncol 11:213–217CrossRefGoogle Scholar
  9. 9.
    Som PM, Norton KI, Shugar JM, Reede DL, Norton L, Biller HF, Som ML (1987) Metastatic hypernephroma to the head and neck. Am J Neuroradiol 8(6):1103–1106PubMedGoogle Scholar
  10. 10.
    Boles R, Cerny J (1971) Head and neck metastases from renal carcinomas. Mich Med 70(16):616–618PubMedGoogle Scholar
  11. 11.
    Sgouras ND, Gamatsi IE, Porfyris EA, Lekka JA, Harkiolakis GC, Nikolopoulou SM, Valvis PJ (1995) An unusual presentation of a metastatic hypernephroma to the frontonasal region. Ann Plast Surg 34(6):653–656CrossRefGoogle Scholar
  12. 12.
    Sountoulides P, Metaxa L, Cindolo L (2011) Atypical presentations and rare metastatic sites of renal cell carcinoma: a review of case reports. J Med Case Rep 5(1):429CrossRefGoogle Scholar
  13. 13.
    Matsumoto Y, Yanagihara N (1982) Renal clear cell carcinoma metastatic to the nose and paranasal sinuses. Laryngoscope 92(10):1190–1193CrossRefGoogle Scholar
  14. 14.
    Airoldi M, Succo G, Valente G, Cavalot A, Gabriele P, Bumma C (1995) Head and neck metastases of renal cancer after nephrectomy: a report of 2 cases. Tumori J 81(3):213–214CrossRefGoogle Scholar
  15. 15.
    Pritchyk KM, Schiff BA, Newkirk KA, Krowiak E, Deeb ZE (2002) Metastatic renal cell carcinoma to the head and neck. Laryngoscope 112:1598–1601CrossRefGoogle Scholar
  16. 16.
    Lang EE, Patil N, Walsh RM, Leader M, Walsh MA (2003) A case of renal cell carcinoma metastatic to the nose and tongue. Ear Nose Throat J 82(5):382CrossRefGoogle Scholar
  17. 17.
    Duque-Fisher CS, Casiano R, Vélez-Hoyos A, Londoño-Bustamente AF (2009) Metastasis to the sinonasal region. Acta Otorrinolaringol Esp 60(6):428–431CrossRefGoogle Scholar
  18. 18.
    Nahum AM, Bailey BJ (1963) Malignant tumors metastatic to the paranasal sinuses: case report and review of the literature. Laryngoscope 73(7):942–953CrossRefGoogle Scholar
  19. 19.
    Bernstein JM, Montgomer WW, Balogh K (1966) Metastatic tumors to the maxilla, nose, and paranasal sinuses. Laryngoscope 76(4):621–650CrossRefGoogle Scholar
  20. 20.
    Turner KJ, Moore JW, Jones A, Taylor CF, Cuthbert-Heavens D, Han C, Leek RD, Gatter KC, Maxwell PH, Ratcliffe PJ, Cranston D (2002) Expression of hypoxia-inducible factors in human renal cancer: relationship to angiogenesis and to the von Hippel–Lindau gene mutation. Can Res 62(10):2957–2961Google Scholar
  21. 21.
    Terada N, Hiruma K, Suzuki M, Numata T, Konno A (1998) Metastasis of renal cell cancer to the ethmoid sinus. Acta Oto-Laryngol 118(537):82–86CrossRefGoogle Scholar
  22. 22.
    Ziari M, Shen S, Amato RJ et al (2006) Metastatic renal cell carcinoma to the nose and ethmoid sinus. Urology 67:199CrossRefGoogle Scholar
  23. 23.
    Jonasch E, Gao J, Rathmell WK (2014) Renal Cell Carcinoma. BMJ 349:g4797CrossRefGoogle Scholar
  24. 24.
    Yamazaki K, Sakamoto M, Ohta T, Kanai Y, Ohki M, Hirohashi S (2003) Overexpression of KIT in chromophobe renal cell carcinoma. Oncogene 22(6):847CrossRefGoogle Scholar
  25. 25.
    Moch H, Humphrey P, Ulbright TM, Reuter VE (2016) WHO classification of tumours of the urinary system and male genital organs, 4th edn. IARC Press, LyonGoogle Scholar
  26. 26.
    Jung K, Lein M, Laube C, Lichtinghagen R (2001) Blood specimen collection methods influence the concentration and the diagnostic validity of matrix metalloproteinase 9 in blood. Clin Chim Acta 314(1–2):241–244CrossRefGoogle Scholar
  27. 27.
    Mikami S, Oya M, Mizuno R, Kosaka T, Ishida M, Kuroda N, Nagashima Y, Katsube KI, Okada Y (2016) Recent advances in renal cell carcinoma from a pathological point of view. Pathol Int 66(9):481–490CrossRefGoogle Scholar
  28. 28.
    Motzer RJ, Michaelson MD, Redman BG, Hudes GR, Wilding G, Figlin RA, Ginsberg MS, Kim ST, Baum CM, DePrimo SE, Li JZ (2006) Activity of SU11248, a multitargeted inhibitor of vascular endothelial growth factor receptor and platelet-derived growth factor receptor, in patients with metastatic renal cell carcinoma. J Clin Oncol 24(1):16–24CrossRefGoogle Scholar
  29. 29.
    Pantuck AJ, Zisman A, Belldegrun A (2001) Gene and immune therapy for renal cell carcinoma. Int J Urol 8(7):S1–S4CrossRefGoogle Scholar
  30. 30.
    Pritchyk KM, Schiff BA, Newkirk KA, Krowiak E, Deeb ZE (2002) Metastatic renal cell carcinoma to the head and neck. Laryngoscope 112(9):1598–1602CrossRefGoogle Scholar
  31. 31.
    Ziari M, Shen S, Amato RJ, Teh BS (2006) Metastatic renal cell carcinoma to the nose and ethmoid sinus. Urology 67(1):199CrossRefGoogle Scholar
  32. 32.
    Yagoda A, Bander NH (1989) Failure of cytotoxic chemotherapy, 1983–1988, and the emerging role of monoclonal antibodies for renal cancer. Urol Int 44(6):338–345CrossRefGoogle Scholar
  33. 33.
    Harris DT (1983) Hormonal therapy and chemotherapy of renal-cell carcinoma. Semin Oncol 10(4):422–430PubMedGoogle Scholar
  34. 34.
    Horoszewicz JS, Murphy GP (1989) An assessment of the current use of human interferons in therapy of urological cancers. J Urol 142(5):1173–1180CrossRefGoogle Scholar
  35. 35.
    Ritchie A, Griffiths G, Parmar M, Fossa SD, Selby PJ, Cornbleet MA, Sibley G, Mead GM, Kaye S, Owen JR, Oliver RT (1999) Interferon-alpha and survival in metastatic renal carcinoma: early results of a randomised controlled trial. Lancet 353(9146):14–17CrossRefGoogle Scholar
  36. 36.
    Pyrhönen S, Salminen E, Ruutu M, Lehtonen T, Nurmi M, Tammela T, Juusela H, Rintala E, Hietanen P, Kellokumpu-Lehtinen PL (1999) Prospective randomized trial of interferon alfa-2a plus vinblastine versus vinblastine alone in patients with advanced renal cell cancer. J Clin Oncol 17(9):2859CrossRefGoogle Scholar
  37. 37.
    Rosenberg SA, Yang JC, White DE, Steinberg SM (1998) Durability of complete responses in patients with metastatic cancer treated with high-dose interleukin-2: identification of the antigens mediating response. Ann Surg 228(3):307CrossRefGoogle Scholar
  38. 38.
    Fisher RI, Rosenberg SA, Sznol M, Parkinson DR, Fyfe G (1997) High-dose aldesleukin in renal cell carcinoma: long-term survival update. Cancer J Sci Am 3:S70–S72PubMedGoogle Scholar
  39. 39.
    Vogelzang N, Teh BS, Furge K, Teh BT (2003) Gene expression profiling of renal cell carcinoma and its implications in diagnosis, prognosis, and therapeutics. Adv Cancer Res 89:157–181CrossRefGoogle Scholar

Copyright information

© Association of Otolaryngologists of India 2018

Authors and Affiliations

  • Pooja Dalakoti
    • 1
  • Kailesh Pujary
    • 1
    Email author
  • Balakrishnan Ramaswamy
    • 1
  1. 1.Department of Otolaryngology – Head and Neck Surgery, Kasturba Medical CollegeManipal Academy of Higher EducationManipalIndia

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