Zhang Na, Zhou Bing, Huang Qian, Chen Xiaohong, Cui Shunjiu, Huang Zhenxiao, Sun Yan
Department of Otolaryngology-Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University Department of Otolaryngology-Head and Neck Surgery, Qinhuangdao First Hospital, Hebei Medical University, China.
Medicine (Baltimore). 2018 Apr;97(14):e0286. doi: 10.1097/MD.0000000000010286.
Distant metastasis of clear-cell renal cell carcinoma (ccRCC) to the nasal cavity and paranasal sinus is rare. Endoscopic biopsy used to be performed for diagnosis when it is difficult for complete resection due to intense bleeding during surgery. According to previous literature, the outcomes of metastasis after endoscopic surgery remain unclear.
A 62-year-old man with a history of epistaxis was referred to our institution. The clinical, computed tomography (CT) and magnetic resonance imaging (MRI) examination indicate metastasis to sinonasal sinuses.Diagnoses: He was histopathologically diagnosed with different anatomical structures of nasal cavity and paranasal sinus metastases 6, 14, and 15 years after the initial nephrectomy for ccRCC.
He underwent endoscopic surgery 3 times, once at the time of each metastasis.
He survived for 20 years despite of multitransfers and died due to multiple organ failure.
Metastasis of ccRCC to the nasal cavity and paranasal sinus is characterized by varied growth rates, metastatic times and spreading patterns; ccRCC metastasis should be considered with the presence of hemorrhagic lesions in the nasal cavity and paranasal sinus. Endoscopic surgery is the first-line treatment.
透明细胞肾细胞癌（ccRCC）远处转移至鼻腔和鼻窦罕见。当手术因术中出血剧烈难以完整切除时，以往常采用内镜活检进行诊断。根据既往文献，内镜手术后转移的结局尚不清楚。
一名有鼻出血病史的62岁男性被转诊至我院。临床、计算机断层扫描（CT）和磁共振成像（MRI）检查提示鼻窦转移。
他在初次肾切除治疗ccRCC后6年、14年和15年，经组织病理学诊断为鼻腔和鼻窦不同解剖结构的转移。
他接受了3次内镜手术，每次转移时各进行了一次。
尽管多次转移，他存活了20年，最终死于多器官功能衰竭。
ccRCC转移至鼻腔和鼻窦具有生长速度、转移时间和扩散方式各异的特点；鼻腔和鼻窦出现出血性病变时应考虑ccRCC转移。内镜手术是一线治疗方法。
