台耳醫誌

Metastasis of renal cell carcinoma to the sinonasal cavity is uncommon, and delayed metastasis after radical local treatment is even rarer. Herein, we present a rare clinical case of delayed sinonasal cavity metastasis 5 years after radical nephrectomy for localized renal cell carcinoma. A 58-year-old female patient was referred to our hospital due to recurring nosebleeds and nasal discharge. She had undergone a left radical nephrectomy at another hospital 5 years ago for stage II renal cell carcinoma on the left side and regular follow up in urology found no evidence of local recurrence. A physical examination revealed a swelling in the right nasal cavity along with a tumor and discharge. The computerized tomography scan showed a soft mass in the right nasal cavity with filling defects in the right frontal, maxillary, and ethmoid sinuses, as well as the bilateral sphenoid sinuses. The patient subsequently underwent an endoscopic pansinusectomy and tumor excision. Pathological examination revealed metastatic clear cell renal cell carcinoma and further imaging studies showed no local recurrence or other metastasis. The patient underwent endoscopic radical curettage of the sinuses and adjuvant sunitinib treatment. She recovered well after surgery with no complications from the medical treatment. There was no tumor recurrence after a year of imaging and endoscopic follow-up. This case report highlights the importance of actively investigating when a patient presents with abnormal nosebleeds, and that postoperative follow-up for renal cell carcinoma should not be limited to the surgical site alone.
(J Taiwan Otolaryngol Head Neck Surg 2024; 59:90-95)