Maxillary Sinus Mass as First Presentation of Silent Metastatic Renal Cell Carcinoma

Olfactory cleft mass as the first presentation of asymptomatic metastatic renal cell carcinoma: A case report and review of the literature

INTRODUCTION AND IMPORTANCE

Renal cell carcinoma metastasis in the sinonasal cavities is rare. They account for less than 1 % of all metastases of these renal cancers.

CASE PRESENTATION

We report the case of a patient with an unremarkable pathological history, who consulted for recurrent right epistaxis. Nasal endoscopy revealed a reddish mass located medial to the right middle turbinate. Computed tomography and magnetic resonance imaging showed a lesion located at the level of the olfactory cleft. The patient had a complete removal of the mass and the anatomopathological examination concluded to a metastasis of a clear cell carcinoma of renal origin. Taking into account these results, a thoraco-abdomino-pelvic CT scan was performed and it discovered a left renal tumor.

CLINICAL DISCUSSION

The most frequent functional sign of Renal cell carcinoma metastases is epistaxis. This is explained by the rich vascularity of these metastases. The imaging data are not specific and do not allow differentiation between primary tumor and metastasis. The definitive diagnosis can be confirmed only by histologic examination.

CONCLUSION

Faced with any hypervascularized tumor of the nasal cavity, the ENT physician must evoke a metastasis of a renal cancer, even in the absence of history and symptoms evoking this cancer.

Clinicopathological features of 214 maxillary sinus pathologies. A ten-year single-centre retrospective clinical study

BACKGROUND

Diagnosis of maxillary sinus pathology must include the clinical radiological study (CRS) and histopathological analysis. The aim of this study is 1) to describe the clinicopathological features of maxillary sinus lesions, obtained successively in a single medical centre over the last 10 years and 2) to determine the sensitivity and specificity for the diagnosis of malignant lesions based exclusively on the CRS.

METHODS

It is a single-centre observational retrospective clinical study on patients who attended the University Hospital Complex of Santiago de Compostela (CHUS) with sinus pathologies during the period of 2009-2019.

RESULTS

The sample consisted of 133 men (62.1%) and 81 women (37.9%), with an average age of 46.9 years (SD = 18.8). In terms of frequency, the most frequent pathology was the unspecified sinusitis (44.4%), followed by polyps (18.2%), malignant tumours (9.8%), inverting papilloma (7.5%), fungal sinusitis (4.7%), cysts (3.7%), benign tumours (2.3%), mucocele (2.3%) and other lesions (1.9%). Cysts and benign tumours were diagnosed earliest Vs malignant tumours (65.2 years (SD = 16.1)) were diagnosed the latest (p < 0.001). Based only on the CRS for malignancies, diagnostic indexes were 71.4% sensitivity and 97.9% specificity, with a Kappa value of 0.68 with (p < 0.001).

CONCLUSION

Maxillary sinus pathology is very varied with therapeutic and prognostic repercussions. CRS is sometimes insufficient and histopathological confirmation is essential.