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Case Reports in Otolaryngology
Volume 2017, Article ID 9242374, 5 pages
https://doi.org/10.1155/2017/9242374
Case Report

Metastatic Renal Cell Carcinoma Presenting as a Paranasal Sinus Mass: The Importance of Differential Diagnosis

1Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, Rome, Italy
2Department of Sense Organs, Audiology Section, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
3Department of Otorhinolaryngology, Catholic University of Sacred Heart, Rome, Italy

Correspondence should be addressed to Massimo Ralli; ti.1amorinu@illar.omissam

Received 25 July 2016; Revised 15 November 2016; Accepted 14 December 2016; Published 11 January 2017

Academic Editor: Marco Berlucchi

Copyright © 2017 Massimo Ralli et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Metastases in the paranasal sinuses are rare; renal cell carcinoma is the most common cancer that metastasizes to this region. We present the case of a patient with a 4-month history of a rapidly growing mass of the nasal pyramid following a nasal trauma, associated with spontaneous epistaxis and multiple episodes of hematuria. Cranial CT scan and MRI showed an ethmoid mass extending to the choanal region, the right orbit, and the right frontal sinus with an initial intracranial extension. Patient underwent surgery with a trans-sinusal frontal approach using a bicoronal incision combined with an anterior midfacial degloving; histological exam was compatible with a metastasis of clear cell renal cell carcinoma. Following histological findings, a total body CT scan showed a solitary 6 cm mass in the upper posterior pole of the left kidney identified as the primary tumor. Although rare, metastatic renal cell carcinoma should always be suspected in patients with nasal or paranasal masses, especially if associated with symptoms suggestive of a systemic involvement such as hematuria. A correct early-stage diagnosis of metastatic RCC can considerably improve survival rate in these patients; preoperative differential diagnosis with contrast-enhanced imaging is fundamental for the correct treatment and follow-up strategy.