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Tu Y, Yu P, Yu L, Ji H, Wan Y, Shi L, Chen A, Zhong F. A Rare Case of Metastatic Clear Cell Renal Cell Carcinoma to the Petroclival Region Presenting as Posterior Cranial Neuropathies. EAR, NOSE & THROAT JOURNAL 2023:1455613231182670. [PMID: 37568274 DOI: 10.1177/01455613231182670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/13/2023] Open
Abstract
We present a case of metastatic renal cell carcinoma (RCC) to the petroclival region with clinical symptoms manifested as posterior cranial neuropathies. A 65-year-old male presented with headache symptom for over 1 year, during which time he was diagnosed with RCC and underwent right nephrectomy. However, the headache symptom and cranial neuropathies had been attributed to cranial neuritis all the time until the surgical removal of metastatic tumor in the petroclival region led to the diagnosis of metastatic RCC. RCC has a tendency for metastasis early. The incidence of spread of RCC to brain is a rarity in clinical practice. When a patient presents with cranial nerve neuropathies, the possibility of metastatic RCC should be sought. Brain metastases display nonspecific presentations, and it is useful to examine with magnetic resonance imaging and computed tomography scans radiologically.
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Affiliation(s)
- Yanyi Tu
- Department of Otolaryngology-Head and Neck Surgery, Shandong Provincial ENT Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Peng Yu
- Department of Otolaryngology-Head and Neck Surgery, Shandong Provincial ENT Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Liang Yu
- Department of Otolaryngology-Head and Neck Surgery, Shandong Provincial ENT Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Hongzhi Ji
- Department of Otolaryngology-Head and Neck Surgery, Shandong Provincial ENT Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Yuzhu Wan
- Department of Otolaryngology-Head and Neck Surgery, Shandong Provincial ENT Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Li Shi
- Department of Otolaryngology-Head and Neck Surgery, Shandong Provincial ENT Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Aiping Chen
- Department of Otolaryngology-Head and Neck Surgery, Shandong Provincial ENT Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Feng Zhong
- Department of Nursing, Shandong Second Provincial General Hospital, Jinan, China
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2
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Unusual head and neck presentation of metastatic renal cell carcinoma. OTOLARYNGOLOGY CASE REPORTS 2023. [DOI: 10.1016/j.xocr.2022.100502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
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Jozsa F, Das JM. Metastatic Lesions of the Clivus: A Systematic Review. World Neurosurg 2021; 158:190-204. [PMID: 34861450 DOI: 10.1016/j.wneu.2021.11.105] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 11/23/2021] [Accepted: 11/24/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND Metastatic lesions of the clivus are extremely rare, having previously been estimated as representing 0.02% of all intracranial tumors. Owing to its close intracranial relationship with the clivus before entering the cavernous sinus, clinical palsies of the sixth cranial nerve have been classically associated with destructive lesions of this structure. METHODS A comprehensive search of PubMed was conducted for studies of patients with metastasis to the clivus from primary cancer at any site. Studies reported in English in the past 20 years from our last search on April 12, 2021 were included. The data collected included patient age, sex, symptoms at presentation, histopathology and treatment timeline of the primary tumor, treatment, follow-up, and mortality. RESULTS After the literature review, 46 studies reporting on 58 patients with clivus metastasis were included in the final analysis. The mean age of the patients was 57.5 years, and 39 were male (67.2%). The most common sites of the primary tumor were the prostate (22%), gastrointestinal tract (15%), lung (13%), and kidney (11%). In 43% of patients, symptoms of clivus metastasis had presented before the diagnosis of primary cancer was known, and 71% of the patients had presented with sixth nerve palsy. Of the 58 patients, 53% had undergone surgery, and 37% had received adjuvant radiotherapy. Of the 58 patients, 25% had received radiotherapy alone. The endoscopic transsphenoidal approach to the clivus was almost uniquely used for surgical management. Survival data were available for 31 patients. Death had occurred at a mean of 9.4 months after the presentation of clivus metastasis. A strong correlation was found between the interval from primary cancer to the presentation of clivus metastasis and mortality. CONCLUSIONS Although an extremely rare occurrence, clivus metastasis should be considered in patients with a history of malignancy, in particular, prostate malignancy, presenting with new-onset isolated sixth nerve palsy.
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Affiliation(s)
- Felix Jozsa
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, United Kingdom.
| | - Joe M Das
- Department of Neurosurgery, Bahrain Specialist Hospital, Juffair, Bahrain
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Salaud C, Roualdes V, Thillays F, Martin SA, Buffenoir K. Trigeminal Ganglion Metastasis of Renal Clear Cell Carcinoma: Cases Report and Review of the Literature. World Neurosurg 2019; 128:541-546. [PMID: 31059855 DOI: 10.1016/j.wneu.2019.04.230] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 04/26/2019] [Accepted: 04/27/2019] [Indexed: 11/09/2022]
Abstract
BACKGROUND The trigeminal ganglion is an atypical site for metastasis, especially for renal clear cell carcinoma. CASE DESCRIPTION We report 2 clinical cases of a 66-year-old man and a 58-year-old man with trigeminal symptoms. Both patients had a history of renal clear cell (RCC) that was considered to be cured at 6 and 9 years, respectively. Brain magnetic resonance imaging (MRI) showed a trigeminal ganglion lesion with increased gadolinium enhancement associated with petrous apex erosion. The main diagnostic hypothesis based on MRI was trigeminal schwannoma for both patients. One patient underwent subtotal removal, the other a biopsy. Histologic examinations resulted in the diagnosis of RCC metastasis. Body computed tomography revealed pancreatic metastasis for both but no renal recurrence. The patients were treated by local radiotherapy, and 1 of the patients had associated chemotherapy. We added to these clinical cases a literature review of skull base metastasis of RCC. Trigeminal ganglion metastasis of RCC is very rare and can persist until 10 years after the first RCC diagnosis. It seems that the best treatment is surgical removal. To date, the role of local radiotherapy is not demonstrated, and the prognosis seems to be poor. CONCLUSIONS In the case of trigeminal symptoms, rapid tumoral growth on brain MRI, or a history of RCC, we think that a body computed tomography should be performed, and surgery should be considered.
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Affiliation(s)
- Céline Salaud
- Department of Neurotrauma/Neurosurgery, Nantes University Hospital, Saint-Herblain, France.
| | - Vincent Roualdes
- Department of Neurotrauma/Neurosurgery, Nantes University Hospital, Saint-Herblain, France
| | - François Thillays
- Department of Radiotherapy, Institut de Cancérologie de l'Ouest, Saint-Herblain, France
| | - Stéphane André Martin
- Department of Neurotrauma/Neurosurgery, Nantes University Hospital, Saint-Herblain, France
| | - Kévin Buffenoir
- Department of Neurotrauma/Neurosurgery, Nantes University Hospital, Saint-Herblain, France
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Bastier PL, Dunion D, de Bonnecaze G, Serrano E, de Gabory L. Renal cell carcinoma metastatic to the sinonasal cavity: A review and report of 8 cases. EAR, NOSE & THROAT JOURNAL 2019; 97:E6-E12. [PMID: 30273434 DOI: 10.1177/014556131809700902] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Renal cell carcinoma (RCC) metastatic in the sinonasal cavity is rare. In many cases, it represents the initial presentation of RCC. We conducted a retrospective chart review to report the clinical presentation, imaging, and treatment of RCC metastases in the sinonasal cavity at two tertiary care referral centers. Our population was made up of 8 patients-6 men and 2 women, aged 55 to 86 years (mean: 66.9; median: 63.5)-who had been diagnosed with cancer in the sinonasal cavity. The most common complaints were epistaxis, nasal obstruction, and diplopia. Cancers were located in the ethmoid sinus (n = 3), nasal cavity (n = 2), sphenoid sinus (n = 2), and maxillary sinus (n = 1). Local treatment involved resection and adjuvant radiotherapy in 4 patients, surgery alone in 2 patients, and radiotherapy alone in the other 2. The lesion was embolized before surgery in 4 cases. We also performed a critical review of similar published cases. Our literature review covered 53 cases of RCC metastatic to the sinonasal cavity, including ours. Metastases were the first presentation of RCC in 24 of these cases (45.3%); in our series, the metastases led to the diagnosis of the primary RCC in 3 cases (37.5%). In the 53 reported cases, metastatic resection was performed on 35 patients (66.0%). Survival data were available for 22 of these operated patients, and 17 of them achieved a complete local response. Adjunctive radiotherapy was not associated with a better local response. Overall survival was significantly better in patients who had an isolated metastasis rather than multiple metastases (p = 0.013). There was no difference in overall survival between patients whose metastasis represented the initial presentation of RCC and those whose metastasis did not (p = 0.95). We recommend that sinonasal metastasis be suspected in the event of unilateral nasal bleeding or nasal obstruction in patients diagnosed with RCC. Embolization may prevent abundant bleeding during removal. Surgery may improve the quality of life of these patients while decreasing nasal obstruction and bleeding.
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Affiliation(s)
- Pierre-Louis Bastier
- Department of Otorhinolaryngology-Head and Neck Surgery, Bordeaux University Hospital, Place Amélie Raba-Leon, 33000 Bordeaux, France.
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Zhang WQ, Bao Y, Qiu B, Wang Y, Li ZP, Wang YB. Clival metastasis of renal clear cell carcinoma: Case report and literature review. World J Clin Cases 2018; 6:301-307. [PMID: 30211212 PMCID: PMC6134277 DOI: 10.12998/wjcc.v6.i9.301] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2018] [Revised: 06/07/2018] [Accepted: 06/27/2018] [Indexed: 02/05/2023] Open
Abstract
The clivus is an atypical metastatic site for renal clear cell carcinoma (RCCC). Here we report a 54 year old man with acute cavernous sinus syndrome. Brain magnetic resonance imaging identified a clival-based lesion with associated bony erosion. The patient underwent endoscopic endonasal biopsy and partial resection of the clival mass. Because histologic examination of the resected specimen resulted in a diagnosis of RCCC, contrast-enhanced computed tomography scan of the abdomen was performed and showed an enhanced left renal mass. The patient subsequently underwent laparoscopic left radical nephrectomy and gamma knife was planned for the residual clival lesion. We also retrospectively reviewed available published reports on clival metastases, specifically those from RCCC, since 1990.
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Affiliation(s)
- Wei-Qi Zhang
- Department of Neurosurgery, First Affiliated Hospital of China Medical University, Shenyang 110001, Liaoning Province, China
| | - Yue Bao
- Department of Neurosurgery, First Affiliated Hospital of China Medical University, Shenyang 110001, Liaoning Province, China
| | - Bo Qiu
- Department of Neurosurgery, First Affiliated Hospital of China Medical University, Shenyang 110001, Liaoning Province, China
| | - Yong Wang
- Department of Neurosurgery, First Affiliated Hospital of China Medical University, Shenyang 110001, Liaoning Province, China
| | - Zhi-Peng Li
- Department of Neurosurgery, First Affiliated Hospital of China Medical University, Shenyang 110001, Liaoning Province, China
| | - Yi-Bao Wang
- Department of Neurosurgery, First Affiliated Hospital of China Medical University, Shenyang 110001, Liaoning Province, China
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Harrison RA, Nam JY, Weathers SP, DeMonte F. Intracranial dural, calvarial, and skull base metastases. HANDBOOK OF CLINICAL NEUROLOGY 2018; 149:205-225. [PMID: 29307354 DOI: 10.1016/b978-0-12-811161-1.00014-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Metastatic disease to the intracranial dura, the calvarium, and the skull base is relatively uncommon but presents unique diagnostic and management challenges in the patient with cancer. Modern imaging techniques have facilitated the detection of intracranial tumor deposits, leading to increased incidence. While dural and calvarial metastases often present with nonspecific symptoms, skull base metastases present with distinct clinical syndromes dependent on the local neurovascular structures affected. Intracranial dural metastases can often be confused with meningioma and pose a diagnostic challenge, as well as significant neurologic morbidity, especially in the setting of hemorrhage. Surgical intervention may be helpful in selected patients for symptomatic relief as well as survival benefit. Management paradigms need to take into account the relative risks, benefits, and likely outcomes for each possible modality of treatment. Surgical excision is useful in many patients and in combination with radiation therapy can provide significant palliation. While medical therapy is rarely an initial therapy in these entities, it may be of added benefit dependent on the underlying tumor histology and prior treatment history. Occasionally treatment with curative intent is justified.
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Affiliation(s)
- Rebecca A Harrison
- Department of Neuro-Oncology, University of Texas M.D. Anderson Cancer Center, Houston, TX, United States
| | - Joo Yeon Nam
- Department of Neuro-Oncology, University of Texas M.D. Anderson Cancer Center, Houston, TX, United States
| | - Shiao-Pei Weathers
- Department of Neuro-Oncology, University of Texas M.D. Anderson Cancer Center, Houston, TX, United States
| | - Franco DeMonte
- Department of Neurosurgery, University of Texas M.D. Anderson Cancer Center, Houston, TX, United States.
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Mani A, Yadav P, Paliwal VK, Lal H. Isolated clival metastasis: a rare presentation of renal cell carcinoma. BMJ Case Rep 2017; 2017:bcr-2017-221570. [PMID: 28801336 DOI: 10.1136/bcr-2017-221570] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Renal cell carcinoma accounts for 3% of all adult malignancies. Usual sites of metastasis are lymph nodes, lungs, bone, liver and brain. We describe a patient who presented with complaints of holocranial headache and diplopia. MRI of the head showed a clival-based lesion with associated bony erosion. With suspicion of a metastatic lesion, an ultrasonogram of the abdomen was done which showed a left renal mass that enhanced on contrast-enhanced CT. There were no other metastatic foci. Patient underwent radiotherapy for the clival lesion. This case report emphasises on the evaluation of clival lesion with cranial neuropathies for a possibility of a renal primary tumour.
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Affiliation(s)
- Anil Mani
- Department of Urology and Renal Transplant, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Priyank Yadav
- Department of Urology and Renal Transplant, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Vimal Kumar Paliwal
- Department of Neurology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Hira Lal
- Department of Radiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
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Babashahi A, Taheri M. A huge and invasive skull metastasis caused by renal cell carcinoma. IRANIAN JOURNAL OF NEUROLOGY 2017; 16:103-104. [PMID: 28761635 PMCID: PMC5526776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Dekker SE, Wasman J, Yoo KK, Alonso F, Tarr RW, Bambakidis NC, Rodriguez K. Clival Metastasis of a Duodenal Adenocarcinoma: A Case Report and Literature Review. World Neurosurg 2016; 100:62-68. [PMID: 28034818 DOI: 10.1016/j.wneu.2016.12.078] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Revised: 12/16/2016] [Accepted: 12/18/2016] [Indexed: 12/19/2022]
Abstract
BACKGROUND Clival metastases of adenocarcinomas are exceptionally rare tumors, especially when they arise from the small intestine. We present the first, to our knowledge, report of a metastasis of a duodenal adenocarcinoma to the clivus. We also present a systematic review detailing metastasis to the clivus. METHODS Studies were identified using the search terms "clival metastasis," "skull base metastasis," and "clivus" in PubMed. We collected the following information: histopathology of the primary tumor, symptoms, history, treatment, and follow-up. RESULTS A comprehensive review of the literature yielded 56 cases. Patients developed the first symptoms of clival metastasis at a mean age of 58 years. The most common primary neoplasms originated from the prostate, kidney, or liver. Most patients presented with an isolated sixth nerve palsy or diplopia. The time interval from diagnosis of the primary tumor to symptomatic presentation of clival metastasis ranged from 2 months to 33 years. Sixteen patients initially presented with symptoms of clival metastasis without a previously diagnosed primary tumor. Survival data were available for 35 patients, of which 63% died within a range of 2 days to 31 months after initial presentation. CONCLUSIONS Most primary neoplasms originated from the prostate, kidney, and liver, which differ from previous reports on skull base metastases. Abducens nerve palsy is often the first presentation of clival metastasis. Clival metastasis from duodenal carcinoma, although very rare, should be considered in the differential diagnosis of bony lesions of the clivus in a patient with a history of duodenal adenocarcinoma.
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Affiliation(s)
- Simone E Dekker
- Department of Neurological Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA.
| | - Jay Wasman
- Department of Pathology, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Kevin K Yoo
- Department of Neurological Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Fernando Alonso
- Department of Neurological Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Robert W Tarr
- Department of Radiology, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Nicholas C Bambakidis
- Department of Neurological Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Kenneth Rodriguez
- Department of Otolaryngology, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
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Wang A, Kleinman G, Murali R, Wainwright J, Tandon A. Metastatic Renal Cell Carcinoma Mimicking Trigeminal Schwannoma in a Patient Presenting with Trigeminal Neuralgia. J Neurol Surg Rep 2015; 76:e282-6. [PMID: 26623243 PMCID: PMC4648722 DOI: 10.1055/s-0035-1566125] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Accepted: 08/19/2015] [Indexed: 11/26/2022] Open
Abstract
We present an unusual case of a metastatic renal cell carcinoma (RCC) mimicking trigeminal schwannoma. The patient, with no prior history of RCC, presented with clinical symptoms and imaging consistent with trigeminal neuralgia secondary to trigeminal schwannoma. Magnetic resonance imaging of the brain showed a large bilobed cystic/solid mass primarily in the cerebellopontine angle cistern, with extension into the left middle cranial fossa, Meckel cave, and left cavernous sinus. Following surgical excision, histopathology revealed the tumor to be an RCC infiltrating into the trigeminal nerve fascicles. Further imaging and investigation revealed widespread metastasis to the vertebral bodies and long bones. Metastatic RCC to the trigeminal nerve is rare. Despite the development of more effective treatment modalities, the prognosis of metastatic RCC remains poor. To our knowledge, this is the first reported case of RCC metastasizing to the trigeminal nerve fascicles.
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Affiliation(s)
- Arthur Wang
- Department of Neurosurgery, New York Medical College, Westchester, Valhalla, New York, United States
| | - George Kleinman
- Department of Pathology, New York Medical College, Westchester, Valhalla, New York, United States
| | - Raj Murali
- Department of Neurosurgery, New York Medical College, Westchester, Valhalla, New York, United States
| | - John Wainwright
- Department of Neurosurgery, New York Medical College, Westchester, Valhalla, New York, United States
| | - Adesh Tandon
- Department of Neurosurgery, New York Medical College, Westchester, Valhalla, New York, United States
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Mendelson ZS, Patel AA, Eloy JA, Liu JK. Endoscopic palliative decompression of the cavernous sinus in a rare case of a metastatic renal cell carcinoma to the clivus. Br J Neurosurg 2014; 29:430-1. [PMID: 25488389 DOI: 10.3109/02688697.2014.987217] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
We present a rare case of acute cavernous sinus syndrome due to a renal cell carcinoma metastasis to the clivus. This case highlights the role of palliative endoscopic endonasal decompression of the cavernous sinus to relieve cranial neuropathies, obtain tissue diagnosis, and for cytoreduction in preparation for additional adjuvant therapy.
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Affiliation(s)
- Zachary S Mendelson
- Department of Neurological Surgery, Rutgers New Jersey Medical School , Newark, NJ , USA
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Jindal T, Sinha RK, Mukherjee S, Karmakar D. Calvarial and cutaneous metastasis as the primary presentation of a renal cell carcinoma. BMJ Case Rep 2014; 2014:bcr-2013-202830. [PMID: 24842354 DOI: 10.1136/bcr-2013-202830] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Renal cell carcinoma is an aggressive urological malignancy. Metastases from the lesion are encountered late in the course of the disease and most often involve the lung and the liver. It is rare that metastatic lesions are the primary presentation of an otherwise clinically silent renal cell carcinoma. We report a case who presented with calvarial and cutaneous lesions which were later found to be metastases from an asymptomatic renal cell carcinoma.
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Affiliation(s)
- Tarun Jindal
- Department of Urology, CNMCH, Kolkata, West Bengal, India
| | | | | | - Dilip Karmakar
- Department of Urology, CNMCH, Kolkata, West Bengal, India
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