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Epistaxis as the First Manifestation of Silent Renal Cell Carcinoma: A Case Report with Relevant Literature Review.

Lee SM, Kim YM, Kim BM - Iran J Radiol (2016)

Bottom Line: Metastatic tumors in the paranasal sinuses are distributed in the maxillary, sphenoid, ethmoid, and frontal sinuses, in order of decreasing frequency.Symptoms are usually nonspecific, but epistaxis is the most common sign, due to the hypervascularity of the primary tumor.The prognosis is uncertain, but the 5-year survival rate fluctuates between 15% and 30%.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Dankook University Hospital, Choenan, South Korea.

ABSTRACT
The paranasal sinuses are known to be a rare location for metastasis. Renal cell carcinoma (RCC) is the most frequent primary tumor to metastasize to the sinonasal region, followed by lung and breast cancer. In particular, clear cell type RCC, which represents approximately 85% of RCCs, is characterized by early metastasis, and it sometimes spreads to unusual sites (1, 2). Metastatic tumors in the paranasal sinuses are distributed in the maxillary, sphenoid, ethmoid, and frontal sinuses, in order of decreasing frequency. Symptoms are usually nonspecific, but epistaxis is the most common sign, due to the hypervascularity of the primary tumor. The prognosis is uncertain, but the 5-year survival rate fluctuates between 15% and 30%. The purpose of this case report is to document a rare case of silent RCC that first presented as epistaxis due to nasal cavity and ethmoid sinus metastasis.

No MeSH data available.


Related in: MedlinePlus

Sixty two-year-old man with nasal metastasis from silent renal cell carcinoma. A, On nasal endoscopy, a hyperemic and hemorrhagic nasal lesion occupying the right middle meatus was noted; B, Axial CT scan showed an oval-shaped, soft-tissue-density mass in the right ethmoid sinus, extending into the nasal cavity with avid enhancement; C, On MRI, a 2.2 cm, oval-shaped, right sinonasal mass appeared hyperintense on T2WI and isointense on T1WI, with strong enhancement; D, On contrast-enhanced 3D CT images of the kidneys, a heterogeneously enhancing lobulated mass measuring 9.7 × 8.5 cm was found in the upper polar region of the left kidney. Round high-densities represent prominent vascular collaterals. The tumor mass engulfed the left proximal ureter with irregular luminal narrowing (arrowhead).
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fig26985: Sixty two-year-old man with nasal metastasis from silent renal cell carcinoma. A, On nasal endoscopy, a hyperemic and hemorrhagic nasal lesion occupying the right middle meatus was noted; B, Axial CT scan showed an oval-shaped, soft-tissue-density mass in the right ethmoid sinus, extending into the nasal cavity with avid enhancement; C, On MRI, a 2.2 cm, oval-shaped, right sinonasal mass appeared hyperintense on T2WI and isointense on T1WI, with strong enhancement; D, On contrast-enhanced 3D CT images of the kidneys, a heterogeneously enhancing lobulated mass measuring 9.7 × 8.5 cm was found in the upper polar region of the left kidney. Round high-densities represent prominent vascular collaterals. The tumor mass engulfed the left proximal ureter with irregular luminal narrowing (arrowhead).

Mentions: On nasal endoscopy, a very hyperemic polypoid mass in the right nasal cavity was noted (Figure 1A). Computed tomography (CT) of the paranasal sinuses revealed an approximately 2.2 cm, oval-shaped, soft-tissue-density mass on the pre-contrast images, with avid enhancement in the right ethmoid sinus and nasal cavity (Figure 1B). On magnetic resonance imaging (MRI), the lesion appeared hyperintense on T2 weighted imaging (T2WI) and isointense on T1WI, with strong enhancement (Figure 1C). The clinically suspected diagnosis was a hypervascular sinonasal tumor, such as a hemangiopericytoma, hemangioma, or angiofibroma. Endoscopic removal of the right sinonasal mass was performed, and the pathology report suggested metastatic clear cell carcinoma of renal origin.


Epistaxis as the First Manifestation of Silent Renal Cell Carcinoma: A Case Report with Relevant Literature Review.

Lee SM, Kim YM, Kim BM - Iran J Radiol (2016)

Sixty two-year-old man with nasal metastasis from silent renal cell carcinoma. A, On nasal endoscopy, a hyperemic and hemorrhagic nasal lesion occupying the right middle meatus was noted; B, Axial CT scan showed an oval-shaped, soft-tissue-density mass in the right ethmoid sinus, extending into the nasal cavity with avid enhancement; C, On MRI, a 2.2 cm, oval-shaped, right sinonasal mass appeared hyperintense on T2WI and isointense on T1WI, with strong enhancement; D, On contrast-enhanced 3D CT images of the kidneys, a heterogeneously enhancing lobulated mass measuring 9.7 × 8.5 cm was found in the upper polar region of the left kidney. Round high-densities represent prominent vascular collaterals. The tumor mass engulfed the left proximal ureter with irregular luminal narrowing (arrowhead).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4835635&req=5

fig26985: Sixty two-year-old man with nasal metastasis from silent renal cell carcinoma. A, On nasal endoscopy, a hyperemic and hemorrhagic nasal lesion occupying the right middle meatus was noted; B, Axial CT scan showed an oval-shaped, soft-tissue-density mass in the right ethmoid sinus, extending into the nasal cavity with avid enhancement; C, On MRI, a 2.2 cm, oval-shaped, right sinonasal mass appeared hyperintense on T2WI and isointense on T1WI, with strong enhancement; D, On contrast-enhanced 3D CT images of the kidneys, a heterogeneously enhancing lobulated mass measuring 9.7 × 8.5 cm was found in the upper polar region of the left kidney. Round high-densities represent prominent vascular collaterals. The tumor mass engulfed the left proximal ureter with irregular luminal narrowing (arrowhead).
Mentions: On nasal endoscopy, a very hyperemic polypoid mass in the right nasal cavity was noted (Figure 1A). Computed tomography (CT) of the paranasal sinuses revealed an approximately 2.2 cm, oval-shaped, soft-tissue-density mass on the pre-contrast images, with avid enhancement in the right ethmoid sinus and nasal cavity (Figure 1B). On magnetic resonance imaging (MRI), the lesion appeared hyperintense on T2 weighted imaging (T2WI) and isointense on T1WI, with strong enhancement (Figure 1C). The clinically suspected diagnosis was a hypervascular sinonasal tumor, such as a hemangiopericytoma, hemangioma, or angiofibroma. Endoscopic removal of the right sinonasal mass was performed, and the pathology report suggested metastatic clear cell carcinoma of renal origin.

Bottom Line: Metastatic tumors in the paranasal sinuses are distributed in the maxillary, sphenoid, ethmoid, and frontal sinuses, in order of decreasing frequency.Symptoms are usually nonspecific, but epistaxis is the most common sign, due to the hypervascularity of the primary tumor.The prognosis is uncertain, but the 5-year survival rate fluctuates between 15% and 30%.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Dankook University Hospital, Choenan, South Korea.

ABSTRACT
The paranasal sinuses are known to be a rare location for metastasis. Renal cell carcinoma (RCC) is the most frequent primary tumor to metastasize to the sinonasal region, followed by lung and breast cancer. In particular, clear cell type RCC, which represents approximately 85% of RCCs, is characterized by early metastasis, and it sometimes spreads to unusual sites (1, 2). Metastatic tumors in the paranasal sinuses are distributed in the maxillary, sphenoid, ethmoid, and frontal sinuses, in order of decreasing frequency. Symptoms are usually nonspecific, but epistaxis is the most common sign, due to the hypervascularity of the primary tumor. The prognosis is uncertain, but the 5-year survival rate fluctuates between 15% and 30%. The purpose of this case report is to document a rare case of silent RCC that first presented as epistaxis due to nasal cavity and ethmoid sinus metastasis.

No MeSH data available.


Related in: MedlinePlus