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A Rare Cause of Nasal Obstruction: Metastatic Renal Cell Carcinoma

View Article: PubMed Central - PubMed

ABSTRACT

Introduction. Renal cell carcinoma can present with several interesting symptoms, paraneoplastic syndromes, and unusual metastatic sites. Head and neck region is one of the rare locations for renal cell carcinoma metastasis. Case Report. A 50-year-old man was admitted to the hospital with nasal congestion and snoring. Physical examination revealed nasal serous secretion. First taken biopsy was misinterpreted. The symptoms of the patient were not revealed and he was readmitted to the hospital. On radiologic examination, a vascular rich mass in maxillary sinus extending to the nasal cavity was observed. Biopsy was diagnosed as renal cell carcinoma metastasis. Herein, we present a patient with renal cell carcinoma presenting nasal obstruction and snoring as first and recurrent symptom.

No MeSH data available.


Dilated blood vessels in a loose stroma (H&E, ×10).
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fig1: Dilated blood vessels in a loose stroma (H&E, ×10).

Mentions: A 50-year-old man has been suffering from nasal obstruction and snoring for 2 months and was admitted to our hospital. His medical history revealed that he had total thyroidectomy and an operation for nasal septum deviation 30 years ago. He did not complain about nasal discharge, nasal itching, or sneezing. On physical examination, there was a serous secretion on nasal mucosa and nasal septum deviated to the right in the posterior portion. A small biopsy was taken and sent to the pathology. Brown-black coloured and soft specimen was measured 0.7 × 0.4 × 0.2 cm in size. In microscopic evaluation, several dilated blood vessels in a loose stroma were observed (Figure 1).  A few cells with foamy cytoplasm were seen and were interpreted as histiocytes and they were reported as vascular rich lesion suggesting hemangioma. A few months later, the patient was readmitted to the hospital with similar complaints and additionally with a swelling of left half of his face. On sinonasal MRA, a heterogeneous mass was seen in maxillary sinus, extending to the nasal cavity and infiltrating nasal conchae. The patient underwent an operation. The maxillary sinus was curetted, and several biopsies were taken from sinus mucosa. On histologic examination, largely dilated, thin-walled vessels were observed in a loose stroma similar to the first biopsy. However, between blood vessels, few histiocyte-like cells with bland nucleus and foamy/clear cytoplasm stood out without forming a distinctive pattern (Figure 2). Although the patient does not have any complaint of flank pain or hematuria, metastatic renal cell carcinoma was suspected and urgent urologic consult was asked for. CD10, EMA, PanCK, and Vimentin immunohistochemistry were applied to determine the origin of the clear cells. These cells were stained positively with all these antibodies. (See Figures 3 and 4; for Vimentin and CD10 staining, resp.) In addition to that, on abdominal CT, a heterogeneous exophytic mass was observed. It was 12 × 12 × 10 cm in size, located in middle-to-upper portion of left kidney, and had cystic and necrotic areas. The sinonasal biopsy was diagnosed as metastatic renal cell carcinoma. Surgical and medical treatment of the patient was made in another hospital. One year later, the lesion recurred and the patient came up again in ear-nose-throat clinic with similar signs and symptoms. On physical examination, there was a polypoid mass extending to inferior nasal concha of left nasal cavity. Total maxillectomy was made and specimen was reported again as metastatic renal cell carcinoma. Any solid organ metastasis was not detected in this time.


A Rare Cause of Nasal Obstruction: Metastatic Renal Cell Carcinoma
Dilated blood vessels in a loose stroma (H&E, ×10).
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC5120200&req=5

fig1: Dilated blood vessels in a loose stroma (H&E, ×10).
Mentions: A 50-year-old man has been suffering from nasal obstruction and snoring for 2 months and was admitted to our hospital. His medical history revealed that he had total thyroidectomy and an operation for nasal septum deviation 30 years ago. He did not complain about nasal discharge, nasal itching, or sneezing. On physical examination, there was a serous secretion on nasal mucosa and nasal septum deviated to the right in the posterior portion. A small biopsy was taken and sent to the pathology. Brown-black coloured and soft specimen was measured 0.7 × 0.4 × 0.2 cm in size. In microscopic evaluation, several dilated blood vessels in a loose stroma were observed (Figure 1).  A few cells with foamy cytoplasm were seen and were interpreted as histiocytes and they were reported as vascular rich lesion suggesting hemangioma. A few months later, the patient was readmitted to the hospital with similar complaints and additionally with a swelling of left half of his face. On sinonasal MRA, a heterogeneous mass was seen in maxillary sinus, extending to the nasal cavity and infiltrating nasal conchae. The patient underwent an operation. The maxillary sinus was curetted, and several biopsies were taken from sinus mucosa. On histologic examination, largely dilated, thin-walled vessels were observed in a loose stroma similar to the first biopsy. However, between blood vessels, few histiocyte-like cells with bland nucleus and foamy/clear cytoplasm stood out without forming a distinctive pattern (Figure 2). Although the patient does not have any complaint of flank pain or hematuria, metastatic renal cell carcinoma was suspected and urgent urologic consult was asked for. CD10, EMA, PanCK, and Vimentin immunohistochemistry were applied to determine the origin of the clear cells. These cells were stained positively with all these antibodies. (See Figures 3 and 4; for Vimentin and CD10 staining, resp.) In addition to that, on abdominal CT, a heterogeneous exophytic mass was observed. It was 12 × 12 × 10 cm in size, located in middle-to-upper portion of left kidney, and had cystic and necrotic areas. The sinonasal biopsy was diagnosed as metastatic renal cell carcinoma. Surgical and medical treatment of the patient was made in another hospital. One year later, the lesion recurred and the patient came up again in ear-nose-throat clinic with similar signs and symptoms. On physical examination, there was a polypoid mass extending to inferior nasal concha of left nasal cavity. Total maxillectomy was made and specimen was reported again as metastatic renal cell carcinoma. Any solid organ metastasis was not detected in this time.

View Article: PubMed Central - PubMed

ABSTRACT

Introduction. Renal cell carcinoma can present with several interesting symptoms, paraneoplastic syndromes, and unusual metastatic sites. Head and neck region is one of the rare locations for renal cell carcinoma metastasis. Case Report. A 50-year-old man was admitted to the hospital with nasal congestion and snoring. Physical examination revealed nasal serous secretion. First taken biopsy was misinterpreted. The symptoms of the patient were not revealed and he was readmitted to the hospital. On radiologic examination, a vascular rich mass in maxillary sinus extending to the nasal cavity was observed. Biopsy was diagnosed as renal cell carcinoma metastasis. Herein, we present a patient with renal cell carcinoma presenting nasal obstruction and snoring as first and recurrent symptom.

No MeSH data available.