J Rhinol.  2021 Mar;28(1):66-71. 10.18787/jr.2020.00342.

Late Metastatic Renal Cell Carcinoma Recurrence Presenting as a Maxillary Sinus Mass 12 Years after Nephrectomy: Case Report and Literature Review

• Joo YH
• Jeon YJ
• Cho HJ
• Kim SW

• KMID: 2513846
• DOI: http://doi.org/10.18787/jr.2020.00342

Abstract

Metastasis to the sinonasal cavity is rare. Late recurrence, such as metastasis developing 10 years or more after nephrectomy, is even more rare. We present a rare case of late metastatic renal cell carcinoma (RCC) in the maxillary sinus after nephrectomy and discuss reported sinonasal metastatic RCC cases. A 64-year-old man presented with left nasal obstruction for the previous one year. He had undergone right nephrectomy to treat RCC 12 years prior. Paranasal sinus computed tomography and magnetic resolution imaging revealed a 4.6-cm-diameter mass exhibiting delayed contrast enhancement that filled the left maxillary sinus and the nasal cavity. Histologically, clear cell RCC was diagnosed. We resected the maxillary sinus tumor to resolve the nasal obstruction for palliative symptom relief. There has been no evidence of recurrence to date, 3 years postoperatively. When a patient with a history of RCC presents with a hypervascular paranasal sinus mass, metastatic RCC should be considered, despite history of nephrectomy. It is important to make an appropriate treatment plan depending on extent of metastases and location of the metastatic tumor.

Keyword

Renal cell carcinomaㆍMetastasisㆍParanasal sinusㆍNephrectomy

Figure

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  Fig. 1. The nasal septum is deviated to the right and left inferior turbinate hypertrophy is evident.

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  Fig. 2. Preoperative paranasal sinus CT and MRI. A: Coronal CT view reveals a huge mass in the left maxillary sinus and displacement of the bony nasal septum to the right, accompanied by erosion. B: The axial CT view shows the thinned left maxillary sinus posterior wall. C: T1 MRI shows a huge mass occupying the left maxillary and ethmoid sinuses. D: The T2 image shows a well-circumscribed round mass and secondary maxillary sinusitis. E: Enhanced T1 MRI reveals a well-enhanced round hypervascular mass and secondary left maxillary sinusitis.

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  Fig. 3. Histological findings. Histological examination reveals RCC cells with characteristic clear cytoplasm and neoplastic cells arranged in nests with intervening blood vessels on H&E staining (A, ×200). Immunohistochemistry for CD10 showed increased expression (B, ×200).

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  Fig. 4. Postoperative paranasal sinus CT and endoscopic view. A: Postoperative paranasal sinus MRI revealed no residual mass and a clear sinus. B: After medial maxillectomy, endoscopy revealed a clear maxillary sinus and a well-healed sinus mucosa. No residual mass was evident.

Reference

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