Metastatic Renal Cell Carcinoma of the Sinonasal Cavities and Skull Base: Experience at a Single Institution

Introduction: Metastatic renal cell carcinoma (RCC) of the sinonasal cavities and skull base is rare and poorly defined. The purpose of this study was to comprehensively characterize the patterns of metastasis, presentation, and treatment of metastatic RCC of the sinonasal cavities and skull base.

Methods: A retrospective review of patients presenting to a tertiary academic medical center between 1998 and 2021 was performed. Patients with metastatic RCC of the sinonasal cavities or skull base were included. Outcome measures were presenting symptoms, cranial nerve (CN) deficits, metastasis location, time between RCC and metastasis diagnoses, and metastasis treatment.

Results: Fifteen patients (12 ales, 3 females; mean age: 58.5 years) with metastatic RCC of the sinonasal cavities and skull base have been managed at our institution since 1998. Presentations included loss of taste and smell, diplopia, epistaxis, facial pain, and tongue deviation. 12/15 patients presented with CN deficits: I (n = 1), II (n = 2), III (n = 1), V (n = 1), VI (n = 3), VII (n = 1), XII (n = 3). Metastasis location included the clivus (n = 3), infratemporal fossa (n = 2), masticator space (n = 2), oral cavity (n = 1), paranasal sinuses (n = 4), sella (n = 3). Metastases were the initial presentation of RCC in 4 patients. Eleven patients were already diagnosed with RCC when metastases were discovered. Mean time between RCC and sinonasal or skull base metastasis diagnoses was 8 years (range: 0–16 years), with metastasis-related symptoms beginning up to 3 years before metastasis diagnosis. 11 patients underwent palliative debulking surgery; 1 patient received adjuvant chemotherapy, 3 patients received adjuvant radiotherapy, and 3 patients received adjuvant chemo- and radiotherapy. 4 patients received chemo- and radiotherapy alone. Mean follow-up was 3.8 years (range: 0–15 years). There was no difference in overall survival between the 4 patients whose metastases represented the initial RCC presentation and those 11 patients whose RCC was diagnosed without metastases (p = 0.17).

Conclusion: Metastatic RCC of the sinonasal cavities and skull base has a variable presentation that might include progressive CN deficits, with delays in diagnosis potentially altering approaches to treatment ([Table 1]).

Table 1 Clinical characteristics – summary

Patient#/Age/Sex	Presentation	Location	Treatment
1/59 y/M	Epistaxis/CNI-deficit	Ethmoid sinus	Surgery/RT
2/65 y/M	Diplopia/CNI-deficit	Nasal cavity	Surgery/Chemo
3/71 y/F	CNXII-palsy	Petrous apex	Surgery/CRT
4/76 y/F	CNVI-palsy	Clivus	Surgery
5/64 y/M	CNII-deficit	Sella	Surgery/CRT
6/56 y/M	CNXII-palsy	Jugular foramen	CRT
7/59 y/M	CNV1/3-palsy	Masticator space	Surgery
8/64 y/M	Diplopia/CNIII-palsy	Supraorbital space	Surgery/CRT
9/56 y/M	CNVII-deficit	Oral cavity	Surgery
10/75 y/M	CNVI-palsy	Cavernous sinus	Surgery/RT
11/61 y/M	CNXII-palsy	Clivus	CRT
12/68 y/M	Sinus pain/headaches	Maxillary sinus	Surgery
13/74 y/M	CNV2-hypoesthesia	Orbit	Surgery/RT
14/31 y/F	(Incidental finding)	Tonsil	Chemo
15/81 y/M	Facial pain	Masticator space	CRT

 

MissingLinkText

No conflict of interest has been declared by the author(s).

Publication History

Article published online:
01 February 2023