48: A Case of Metastatic Renal Cell Carcinoma to The Maxillary Sinus Initially Presenting as Recurrent Epistaxis
Location: Poster Hall, Board E8
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Figure 1: Patient Imaging
(A) Initial CT sinus without contrast showing right sided sinonasal tract mass. (B) Follow-up MRI brain imaging confirming R-sided mass. (C) CT abdomen and pelvis showing left sided 4.9 cm renal mass (D) MRI brain imaging at 10-months status-post mass resection and immunotherapy showing resolution of mass (E) MRI abdomen and pelvis imaging 2-months post-cytoreductive nephrectomy (F) MRI brain imaging 2-months post-cytoreductive nephrectomy showing recurrence of right sided mass, noted with blue “X”.
CT = Computerized Tomography; MRI = Magnetic Resonance Imaging
Medical Student McGovern Medical School at UTHealth - Houston Houston, TX, United States
Background: Metastatic neoplasms to the sinonasal tract are rare. However, in the presence of suspected metastasis to this region, renal cell carcinoma is the most commonly implicated primary tumor.
Methods: Here we present an unusual case of a 74-year-old female who was diagnosed with renal cell carcinoma after the discovery of oligometastatic disease to the maxillary sinus first presenting as recurrent epistaxis.
Results: A 74-year-old female presented with a 3-week history of intermittent epistaxis. Medical history included diabetes, hypertension, and atrial fibrillation currently on coumadin. Following spontaneous resolution of epistaxis and an unremarkable workup, patient was discharged with instructions to follow-up with Otolaryngology outpatient. A cranial CT scan obtained by Otolaryngology showed complete opacification of the right frontal, ethmoid, and maxillary sinuses. MRI showed an enhancing right maxillary sinus mass with extension into the nasoethmoidal cavity. Right nasal endoscopy, maxillary antrostomy, and removal of maxillary sinus mass was performed and histological exam revealed cells consistent with metastatic clear cell renal cell carcinoma (ccRCC). CT scan revealed a 4.9-cm left renal mass with bilateral enhancing adrenal nodules and a solitary right lung nodule. Patient was begun on immunotherapy, first Nivolumab/Ipilimumab then switched to Nivolumab/Cabozantinib to minimize continued epistaxis for which concurrent radiation therapy was also used. Ten months into treatment, repeat scans revealed regression of metastatic lesions and primary site renal mass. Decision was made to proceed with cytoreductive nephrectomy one year from discovery of maxillary sinus mass. A 3.5-cm left renal mass was removed. Imaging two months after nephrectomy showed recurrence of maxillary sinus mass. Repeat endoscopic mass resection and debridement with histological exam revealed metastatic ccRCC.
Conclusions: Albeit uncommon, metastatic renal cell carcinoma should be a differential diagnosis in patients presenting with nasal and paranasal sinus masses.
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