A Case of Nasal/Paranasal Metastatic Renal Cell Carcinoma

Abstract

Metastatic renal cell carcinoma of the nasal cavity and paranasal sinus is relatively rarely reported. Recently, we encountered a case of metastasis of renal cell carcinoma to the nasal cavity and paranasal sinus nine years after surgery. An 82-year-old woman visited a clinic with a chief complaint of recurrent nosebleeds. She was diagnosed as having a dark-red hemorrhagic mass in the posterior right nasal cavity, was subsequently referred to our hospital for close examination and treatment of the tumor. An incisional biopsy revealed that the mass was a clear cell carcinoma, and thus a clinical diagnosis of “renal cell carcinoma metastatic to the nasal cavity” was made, as the patient’s history included nephrectomy for renal cell carcinoma nine years prior and hepatectomy for metastatic liver tumor of renal cell carcinoma three years prior. Since the primary lesion in the kidney was being well controlled with pharmacotherapy and no hepatic metastasis was noted, surgical resection of the intranasal tumor was chosen as the preferred approach for treatment of the recurrent nosebleeds. Renal cell carcinoma tumor lesions are rich in blood supply, and in light of the possibility of massive bleeding during the operation, embolization of the feeding artery—the sphenopalatine artery—was performed the day before surgery, markedly reducing blood flow to the lesion. The nasal/paranasal tumor was removed endoscopically. The intraoperative bleeding volume was as low as 300 mL, and a blood transfusion was not required. Although metastatic lesions were detected in other organs after the operation, the patient remains alive at present (18 months post-surgery) despite the presence of tumors. She has not developed recurrent nosebleeds during the postoperative follow-up period. Although tumor metastasis to the nasal cavity and paranasal sinus is rare, the most frequent primary site of a metastatic nasal cavity and paranasal sinus tumor is reported to be the kidney. As such, physicians should consider the possibility of metastasis of renal cell carcinoma if a tumor mass is detected in the nasal cavity and paranasal sinus.