Metastatic renal cell carcinoma involving ethmoid sinus at presentation.
GK Maheshwari, HA Baboo, MH Patel, G Usha
G K Maheshwari
|How to cite this article:|
Maheshwari G K, Baboo H A, Patel M H, Usha G. Metastatic renal cell carcinoma involving ethmoid sinus at presentation. J Postgrad Med 2003;49:96-7
|How to cite this URL:|
Maheshwari G K, Baboo H A, Patel M H, Usha G. Metastatic renal cell carcinoma involving ethmoid sinus at presentation. J Postgrad Med [serial online] 2003 [cited 2021 Jul 29 ];49:96-7
Available from: https://www.jpgmonline.com/text.asp?2003/49/1/96/915
A 57-year-old, normotensive man presented with a one month history of throbbing headache in the right frontal region and three episodes of epistaxis. His otolaryngologic, ophthalmic and systemic examinations were normal. X-ray of paranasal sinuses showed haziness in the right ethmoid region. CT scan of the head showed a soft tissue mass in the right ethmoid region with erosion of the medial wall of the right orbit. Biopsy of the mass on histopathological examination was reported as metastatic clear cell carcinoma. Possibility of primary lesion in the parotid or kidney was suggested. Ultrasonography of the abdomen detected a mixed echogenic mass with irregular and well defined margins and CT scan revealed a non-homogenously enhancing mass at the upper pole of right kidney. CT guided biopsy of the renal mass showed features of clear cell carcinoma. A near total excision of the mass with medial wall of the maxilla , medial orbit and ethmoids via extended Weber-Furguson incision was performed under general anaesthesia. The surgical margins were positive for the tumour. Thus, the patient received post operative radiotherapy. He observed complete relief from symptoms. He refused any surgical procedure for the asymptomatic lesion in his right kidney; thus he was put on hormone therapy (Megestral acetate 300 mg/day). He continues to be in good health and there is no progression of his primary disease or appearance of new metastatic lesions during thirty months post treatment period.
Primary malignant tumours of the nose and paranasal sinuses represents 0.3% of all malignancies and 3% of all cancers in head and neck region. Metastasis to nose and paranasal sinuses is uncommon, with only 105 cases have been reported. Maxillary sinus is most commonly involved. To date, only 21 cases of metastatic involvement of ethmoid sinuses have been reported in the literature.,,, The most common tumours metastasizing to the paranasal sinuses are from the kidney, bronchus, breast, gastrointestinal tract, etc., with renal cell carcinoma accounting for almost 50% of all such cases. About 10% of renal carcinomas present with metastatic manifestations while the primary tumour remains clinically silent. Our patient presented with a solitary metastatic lesion. Headache and epistaxis were only manifestations of his renal cell carcinoma.
There are no specific clinical or radiological features to differentiate metastatic from primary sino-nasal tract lesions. It is not until a biopsy is obtained that the true nature of the tumour becomes evident. Even then, metastases may not show any obvious microscopic features that would readily indicate itís origin. The possible mechanisms of such unusual metastasis include haematogenous, lymphatic or both.
|1||Tariq M, Gluckman P, Thebe P. Metastatic testicular teratoma of the nasal cavity: a rare cause of severe intractable epistaxis. J Laryngol Otol 1998;112:1078-81.|
|2||Nelson EG, Goldman ME, Hemmati M, Metastatic carcinoma of the ethmoid sinus. Otolaryngol Head Neck Surg 1990;103:120-3.|
|3||Mochimatsu A, Tsukuda M, Furakawa S, Sawaki S. Tumors metastasizing to head and neck-a report of seven cases. J Laryngol Otol 1993;107:1171-3. |
|4||Sharma HS, Reddy SC, Mohamad A, Kamal MZ, Halder D. Metastatic osteosarcoma of the ethmoid: an unusual cause of recurrent epistaxis and proptosis. J Laryngol Otol 1996;110:676-8. |
|5||Sesenna E, Tullio A, Piazza P. Treatment of craniofacial metastasis of a renal adenocarcinoma: report of a case and review of literature. J Oral Maxillofac Surg 1995;53:187-93.|