Metastatic Renal Cell Carcinoma of the Head and Neck: A Case Series

BACKGROUND

Renal cell carcinoma (RCC) accounts for over 80% of malignant tumors arising from the kidney. However, metastatic RCC to the head and neck is a relatively rare entity.

CASE PRESENTATION

We describe three patients with metastatic RCC to the head and neck with the involvement of the parapharyngeal space, the level V region of the neck, and the maxillary sinus.

CONCLUSION

Metastatic RCC in the head and neck is uncommon; however, it must be taken into consideration given a patient with a history of RCC. Multiple pathways allow for the spread of RCC to the head and neck region. Treatment options include mastectomy or local radiation and systemic chemotherapy.

Case report. Metastatic renal cell carcinoma to the left maxillary sinus

Metastatic tumors in the paranasal sinuses are very rare. The origin of metastatic tumors in the paranasal sinuses is often renal cancer. Renal cell carcinomas are known for their tendency for early metastasis, and symptoms due to the metastatic lesion may be the only initial manifestation. In this paper, we deal with the case of a 35-year-old male patient who presented with a mass in the left maxillary region. The presence of a primary renal cell carcinoma was recognized only after surgical removal of the metastatic tumor. The presentation, diagnosis and treatment of this tumor are discussed with a review of the literature.

A case of invasive meningioma involving the maxillary sinus

Meningiomas account for nearly 15% of primary brain tumors, but extracranial meningiomas are very rare. We presented a case of invasive maxillary sinus meningioma. A 50-year-old man presented with facial tenderness and severe pain in the left cheek. He had a prior surgery for a meningioma in the left frontal lobe eight months before. Physical examination and computed tomography showed a mass in the left maxillary sinus. Histopathological result of the biopsy obtained via the Caldwell-Luc approach was invasive meningioma. The mass was removed with the sinus mucosa. The histology of the resected specimen was compatible with invasive angioblastic meningioma. Postoperative radiotherapy was administered because of residual intracranial tumor. No recurrence was detected over an 11-month follow-up period.

[Maxillary sinus metastasis of renal cell carcinoma]

Paranasal sinuses and nose metastasis are very uncommon tumors, about 50 have been reported. Renal cell carcinoma is the primary neoplasm which most frequently metastasizes in the nasosinusal region, followed by breast and lung. Symptoms are unspecific, but the epistaxis constitutes the most common sign due to the significant vascularizations of the tumor. Prognosis is poor. The survival rate fluctuates between 15-30% at 5 years. Surgery is the elective treatment.

[Bilateral maxillary sinus metastasis of renal cell carcinoma: a case report]

A 58-year-old man presented with lasting nasal obstruction. He had undergone right nephrectomy for renal cell carcinoma 11 years ago and right lobectomy for pulmonary metastasis 10 years ago. Paranasal sinus CT scans showed a soft tissue mass in the bilateral maxillary sinus. Abdominal CT showed left renal mass. Each mass was enhanced on the contrast-enhanced viewing. The paranasal mass biopsy was performed and resulted in profuse bleeding. Pathological examination was a metastasic renal cell carcinoma. After embolization of feeding artery, debulking surgery was performed. Postoperatively he was given radiotherapy and interferon therapy.

[Metastasis in maxilar sinus as only manifestation of disseminate renal adenocarcinoma]

Paranasal sinuses and nose metastasis are very uncommon. About 50 have been reported. Renal cell carcinoma is the primary neoplasm which most frequently metastasizes in the nasosinusal region, followed by breast and lug. Symptoms are unspecific, but the epistaxis constitutes the most common sign due to the significant vascularizations of the tumor. Prognosis is poor. The survival rate fluctuates between 15-30% at 5 years. Surgery is the elective treatment.

Infratemporal fossa and maxillary sinus metastases from colorectal cancer: a case report

Head and neck metastases from colorectal carcinoma are very rare. We report on a 47-year-old woman who had a vegetating tumor located at the distal sigmoid colon with initial liver metastases. She underwent palliative transverse colostomy to prevent intestinal obstruction. She was then treated with 5-fluorouracil, leucovorin and CPT-11. At the third cycle she presented with toothache and numbness of her upper lip. Computed tomography (CT) of the head and neck showed a gross mass involving the sphenoid sinus, left maxillary sinus, left pterygopalatine plate, pterygopalatine and infratemporal fossa. Histology of the mass revealed metastatic adenocarcinoma which was similar with the primary sigmoid carcinoma. The patient underwent radiotherapy and died 2 months later. Although cranial fossa metastases from colorectal cancer are very rare, the physicians should be aware of this type of metastatic pattern in patients who suffer of toothache, painful mastication or numbness of the lips, especially if decay has not been determined.

A case of metastatic hepatocellular carcinoma in the nasal cavity

Metastatic hepatocellular carcinoma in the nasal cavity and paranasal sinuses is rare. We report the case of a 71-year-old male afflicted with hepatocellular carcinoma with metastasis in the maxillary sinus and nasal cavity. He underwent radiation therapy with a total dose of 36 Gy, but he died of terminal liver failure. The possible metastatic route and prognosis of metastatic hepatocellular carcinoma in the sinonasal tract are discussed.

Adenoid cystic carcinoma of maxillary sinus with metastatic hepatocellular carcinoma. Case report

A case of collision tumor in the left maxillary sinus composed of adenoid cystic carcinoma (ACC) and metastatic hepatocellular carcinoma (HCC) is reported. Radiographic examination revealed masses in the liver and bilateral lung metastases. Histologically, proliferation of tumor cells with resemblance to HCC was observed, in addition to the ACC. For this reason, differential diagnosis between a second primary tumor and metastasis was made. The metastatic lesion immunohistochemically showed positivity for hepatocyte antigen (OCH1E5) and protein induced by vitamin K absence or antagonist II (PIVKA-II), sustaining the HCC diagnosis. Primary ACC and metastatic HCC in the maxillary sinus are rare, and this may therefore be the first case of maxillary sinus tumor with both these elements.

Metastatic tumours in upper maxillary bone of esophageal adenocarcinoma. A case report

Metastases in the oral cavity are rare lesions which represent approximately 1% of all malignant neoplasms in the oral cavity. Oral metastases are located in the mandible 80-90% on average, the maxilla location being rarer. Metastases in mouth soft tissue are also rare, and within these it is on the gums where they more frequently occur. Primary tumours which metastasize to mouth are most commonly: lung, breast and kidney. Oral cavity metastases appear as a result of distant disease spreading and show wrong prognosis, with short survival. Here we present a clinical case of a patient diagnosed with esophagus adenocarcinoma which presented metastasis in upper-left maxillary bone.

Breast carcinoma metastases in paranasal sinuses, a rare occurrence mimicking a primary nasal malignancy. case report

Metastatic tumours to the paranasal sinuses are an exceedingly rare event, the large majority being of renal origin. Herein, a case of metastatic breast carcinoma to the right maxilla is described which occurred 4 years after radical mastectomy, clinically and radiologically presenting as a primary sinonasal mass. Only the histopathologic examination together with a broad spectrum of immunohistochemical antibodies were useful in confirming the origin of the neoplasm.

Metastatic hepatocellular carcinoma of the maxillary sinus: a rare autopsy case without lung metastasis and a review

A rare case of metastatic hepatocellular carcinoma (HCC) of the maxillary sinus in a 67-year-old man is reported along with the findings at autopsy. A fine needle aspiration biopsy specimen revealed a characteristic tumour structure resembling primary HCC. At autopsy, metastatic lesions were recognized in the bilateral adrenals, spleen, sternum, vertebrae and lymph node at the lesser curvature of the stomach, but not in the lung, suggesting that the HCC had metastasized to the maxillary sinus via the plexus venous vertebralis and/or the azygos vein, or lymph duct. In our reviewed 29 cases of metastatic HCC in the oro-maxillofacial region, most patients were men in the 50- to 70-year age range. At least 11 cases did not have lung metastasis, and in 18, metastasis to the oro-maxillofacial region was the first sign of HCC. One should be aware of the possibility to encounter the oral lesion as first sign of metastatic HCC.

Distant metastases of adenoid cystic carcinoma of the salivary glands and the value of diagnostic examinations during follow-up

BACKGROUND

Adenoid cystic carcinoma (ACC) accounts for approximately 10% of all neoplasms of the salivary glands. Late distant metastases and local recurrences are responsible for a rather low long-term survival rate.

AIM

To study the metastasizing pattern of ACC of the salivary glands in 51 patients.

METHOD

Fifty-one patients with an ACC in the intraoral/sublingual salivary glands (n = 30), parotid gland (n = 8), submandibular gland (n = 2), maxillary sinus (n = 6), and nasal cavity (n = 5) have been studied. The male-female ratio was 1:1, the mean age was 54.3 (range, 19-81) years. In 30 cases treatment consisted of surgery and radiotherapy. In 13 cases surgery alone was carried out. The average follow-up time was 117.8 (range, 1-171) months.

RESULTS

In 28 cases (54.9%) distant metastases occurred, and in 3 patients (5.8%) regional lymph node metastases occurred. In 12 of the 28 patients with distant metastases (42.8%), only the lungs were involved, whereas in 5 of the 28 patients (17.8%), the distant metastases occurred in other organs (eg, bones and brain). In 11 of the 28 patients (39.2%) metastases were found both in the lungs and other organs. Twenty-four of the 51 patients (47.0%) died because of their tumor. The average time between the occurrence of lung metastases and death was 32.3 months and between the occurrence of metastases elsewhere and death 20.6 months.

CONCLUSION

Distant metastases of ACC of the salivary glands occur most often in the lungs. Although these lung metastases are the first to occur, these patients die later than patients with distant metastases in other organs. The value of annual chest films or other tests for the presence of distant metastases during follow-up after surgical removal of an ACC seems rather questionable.

[Epistaxis as initial manifestation of disseminated renal adenocarcinoma]

Peculiar renal carcinoma tendency to unusual distant metastases suggest this primary neoplasm to be accounted in differential diagnosis of metastases as first clinical symptom of cancer. Renal cell carcinoma present metastases in 26-30% of cases at the time of diagnosis. Head and neck metastases from renal carcinoma are said to be present in 8% (6-15.2%) of patients, and half of them are asented on paranasal sinuses. We report a 70-years-old patient with recurrent epistaxis as first clinical sign of a nasosinusal metastases from renal disseminated carcinoma, who precised selective embolization. Epidemyologic, diagnostic and therapeutical aspects are briefly reviewed in literature. Nasosinusal metastases are uncommon in clinical practice. We emphasized the need of primary tumor investigation in the organs most often responsible for these metastasic deposits as: kidney (50%), lungs, breast, gastrointestinal tract, urogenital ridge and thyroid gland. Individualized treatment depends on leasions number and localization. On routine follow up of hipernephroma nephrectomized patients a high suspect index has to be considered as paranasal metastases can eventually occur.

Metastasis of maxillary carcinoma to the parapharyngeal space: rationale and technique for concomitant en bloc parapharyngeal dissection

PURPOSE

En bloc resection of the primary tumor and regional lymph nodes is the classic method of surgery in cases of head and neck cancer, but it is not performed in cases of carcinoma of the maxillary gingiva or antrum for anatomic reasons. One of the reasons for the poor prognosis of patients with maxillary cancer and N+ stage necks is thought to be recurrence in the parapharyngeal space, which is out of the surgical field in radical neck dissection. The purpose of this study was to discuss the rationale and indication for en bloc resection and parapharyngeal dissection for maxillary cancer.

PATIENTS AND METHODS

Ninety-nine patients with maxillary cancer (54 in the gingiva and 45 in the antrum) treated at our institution between 1980 and 2000 were studied retrospectively.

RESULTS

In 4 patients, there was recurrence in the parapharyngeal spaces despite good control of tumors in the maxilla and the neck. These 4 patients had all undergone resection of maxilla and neck lymph nodes separately. We also report the case of a patient with carcinoma of the maxillary antrum who underwent en bloc resection of the maxilla and neck. After radical neck dissection, parapharyngeal dissection was performed with a mandibular ramus osteotomy approach, and the maxilla and neck tissue were resected en bloc.

CONCLUSIONS

Although en bloc resection causes more extensive surgical damage, it may be useful in patients with maxillary cancer who have metastasis in the upper jugular lymph nodes.

[Bladder transitional cell carcinoma with metastasis to the maxillary sinus as first symptom]

Maxillary sinus metastasis are very uncommon tumors (fifty have been reported). The most frequent ones are renal adenocarcinoma, breast and lung tumors. Up to now there is only a reported case of bladder carcinoma in maxillary sinus. We report a 67 years old male with a right maxillary tumor two months ago. FNA demonstrated a transitional cell bladder tumor. The treatment was chemotherapy. The patient died two months later. We reported some considerations about metastatic tumors of paranasal sinus.

[Metastases to the paranasal sinuses: case report and review of the literature]

The case of an 87-year old man with widespread prostatic cancer is reported. During the autopsy macroscopically visible metastases were found within the frontal sinuses. These tumor masses destroyed the posterior osseous wall of the frontal sinus and formed polypoid bulging masses. In contrast to the macroscopically unaffected mucous membrane of the sphenoid sinus the maceration specimen of the skull base demonstrated a spongious-mossy, osteoplastic metastasis, lining the sphenoid sinus like a tapestry. This affection started from an exhaustive osteoplastic metastasis within the clivus. No metastases could be found in both antrums or the ethmoids. Retrospectively no symptoms from the paranasal sinuses could be eruated, only occasional pain of the frontal bone. The review of the world literature with 123 reports revealed 169 cases. Renal cell carcinomas most frequently metastasize into the paranasal sinuses (67 cases), followed by bronchogenic carcinomas (15 cases). Thyroid cancers and cancers of the mammary gland are responsible for 13 respectively 14 cases. The prostate also adds 12 cases. The paranasal sinuses are affected in diminishing frequency: maxillary sinus (55 cases), sphenoid sinus (37 cases), ethmoidal cells (23 cases) and frontal sinus (15 cases). In 38 cases exhaustive metastases affecting two or more paranasal sinuses are reported. The statement of literature, that metastases affecting the paranasal sinuses are much more frequent than reported, cannot be supported by our study, because the intensive autoptic investigation of 50 skulls of patients suffering from widespread cancers revealed no further cases of metastatic processes of the paranasal sinuses.

A case of infantile neuroblastoma with intramucosal metastasis in a paranasal sinus

An 8-year-old boy with neuroblastoma of the right adrenal gland is reported. His initial treatment included chemotherapy and surgery, with complete response (CR) being achieved at the initial site. A metastatic lesion was found in the right maxillary sinus 32 months after his initial treatment. A mass in the right soft palate was detected and was clinically suspected of being a metastasis. The results of biopsy were negative and the differential diagnosis from the imaging studies of CT included odontogenic disease, fungal infection, paranasal sinus cyst or hematoma, and benign tumors. Open transantral biopsy was done under general anesthesia, revealing severe inflammation in the right maxillary sinus as well as bone erosion. The histopathological diagnosis was metastatic neuroblastoma from the adrenal lesion. The local field was irradiated with 20 Gy of linear accelerator (linac) radiation, then the local field was eradicated. Extensive skeletal metastases were subsequently found by bone scintigraphy. Despite further treatment his general condition deteriorated rapidly and he died 24 months after starting treatment. We review the previous reports and discuss metastasis to the sinuses.

[Sonographic diagnosis of metastatic renal cell carcinoma to the head and neck region]

In the area of the head and neck metastases from distant primary tumours are rare in comparison to the common squamous cell carcinomas of the upper respiratory and digestive tract. Thus correct preoperative diagnosis may be difficult. Two cases with distant metastases of renal cell carcinoma to the head and neck region are presented in this report. In a 60-year-old male patient, diagnostic evaluation of unilateral epistaxis revealed a radioopacity of the maxillary sinus, six months after removal of a renal cell carcinoma. In the second case a slowly progressive indolent swelling of the left neck developed in a 56-year-old man six years after resection of a renal cell carcinoma and two years after surgical treatment of a pancreatic carcinoma. Following clinical examination, modern imaging techniques with special emphasis on colour Doppler sonography with a Siemens Quantum 2000 were used for diagnostic evaluation in both patients. Sonography of metastatic renal cell carcinoma to the maxillary sinus revealed complete opacity of the antrum. The cervical mass proved to the inhomogeneous and hypoechogenic and was difficult to distinguish from the lower parotid lobe and the vessel sheath. A common feature of both tumours was a high degree of perfusion which could be confirmed by superselective angiography. The histological examination of the surgical specimen showed an isolated metastasis of a renal cell carcinoma in both cases. In patients with a history of renal cell carcinoma the possibility of distant spread to the head and neck region should be taken into account even after a long period of complete remission. Colour Doppler sonography facilitates the distinction between the normally well perfused secondary tumours and squamous cell carcinomas which usually only have a minimal blood supply. Because of the high risk of profuse bleeding a biopsy should only be performed in the operating theatre.

[The paranasal sinuses as metastatic site of renal cell carcinoma]

BACKGROUND

Malignant tumors very seldom establish metastasis in the paranasal sinuses. Renal cell carcinomas (RCC) are one of the possible primary tumors displaying metastases in this location. The incidence of metastasis from the renal cell carcinoma in the paranasal sinuses is higher as would be expected by the incidence of this tumor.

PATIENTS

We report here about 3 patients from the ENT clinic with metastasis in the paranasal sinus derived from primary RCC. Two of them showed metastases in the maxillary sinus and the third patient had a metastasis in the sphenoid sinus.

RESULTS AND CONCLUSIONS

Further progression of the patients disease exhibited the paranasal sinuses being only a localisation of the generalised tumor disease. 2 of 3 patients developed the metastasis many years after nephrectomy and the third patient displayed a renal cell carcinoma by the diagnosis of a paralysis of the abducens nerve. All patients were treated with radiation of the tumor, but in one case with a metastasis in the maxillary sinus the tumor was also treated surgically. 2 of the 3 patients (one with a metastasis in the maxillary sinus and the other in the sphenoidal sinus) were inoperable due to the expanded tumor size. Nowadays surgical resection of the tumor seems to be the only therapy. In the follow-up all patients developed multiple distant metastasis. With respect to the quality of life of the patients the indication of a radical operation should be discussed very critically. Palliative methods, like interferon-therapy or selective embolisation of tumor, may also reduce the symptoms of the tumor and increase the quality of life for the patients.

Extramedullary tumors of myeloid blasts in adults as a pattern of relapse following allogeneic bone marrow transplantation

BACKGROUND

Extramedullary tumors of lymphoid and myeloid blasts outside the well-defined sanctuaries following allogeneic bone marrow transplantation (allo-BMT) are rare. Little is known about the biology, treatment, and outcome of these tumors in this setting.

METHODS

In this retrospective analysis, 134 consecutive patients with acute myeloid leukemia (AML) or chronic myeloid leukemia (CML) who underwent allo-BMT at a single institution between 1990 and 1998 were reviewed. Five cases of isolated extramedullary myeloid sarcoma that occurred as patterns of recurrence following allo-BMT between 1990 and 1998 are reported. These patients were treated with radiotherapy, systemic chemotherapy, or a second allo-BMT. Clinical outcome is compared with posttransplantation bone marrow relapses observed during the same period at the same institution. The literature on the clinical characteristics, currently available treatment, and outcome of posttransplantation myeloid sarcoma patients was reviewed.

RESULTS

Excluding isolated skin and central nervous system recurrences, the frequency of extramedullary myeloid sarcoma encountered as a relapse pattern following allo-BMT was determined to be 3.7% among patients with acute or chronic leukemia of myeloid origin. The survival of patients who were managed with radiotherapy and systemic chemotherapy was less than 4 months. A patient who underwent a second allo-BMT following local radiotherapy is alive and in complete remission more than 33 months after the diagnosis of myeloid sarcoma. The median survival of 17 patients with posttransplantation bone marrow relapse following allo-BMT was 2.2 months. When posttransplantation medullary recurrences are analyzed, patients with CML had a median survival of 12 months, with a significantly better 5-year survival rate than patients with AML (0 vs. 60%, P = 0.015; median survival, 12 months).

CONCLUSIONS

The clinical outcomes of patients with recurrent isolated extramedullary myeloid sarcoma following allo-BMT are poor, as in any leukemic relapse, with the exception of patients with CML in this setting.

[Unusual metastasis of hypernephroma in the maxillary sinus]

BACKGROUND

Metastases of infraclavicular malignancies to the nose and paranasal sinuses are characterized by their untypical symptoms and late clinical manifestation. Metastases of renal carcinoma on paranasal cavities may be highly vasculared and can cause profuse bleeding.

PATIENT

We report a rare case of a 60-year-old man who suffered from a large metastatic hypernephroma to the right maxillary sinus. Intermittent epistaxis and pain were the first symptoms. The patient had undergone a tumor nephrectomy six months previously. The endonasal biopsy of the vascular tumor caused abundant bleeding which required surgical treatment.

RESULTS

The solitary metastasis was resected by a maxillectomy with closure of the large cavity with a microvascular latissimus dorsi flap. Additionally, a conservative treatment of interleukin-2 and alpha-interferon was administered.

CONCLUSIONS

In case of a solitary metastasis of a renal carcinoma, a radical resection should be considered to improve the prognosis. The possibility of extensive perfusion should be taken into account when taking a biopsy of the lesion in order to be prepared for managing bleeding.

Adenosquamous carcinoma. A rare neoplasm with an aggressive course

We report a case of adenosquamous carcinoma that arose in the maxillary alveolus of a 61-year-old woman, metastasized rapidly to submandibular and deep cervical lymph nodes, and caused death in spite of surgery and radiotherapy. Our case highlights the aggressive behavior associated with this tumor when it occurs in the oral cavity and at most other body sites. In addition, the oral adenosquamous carcinoma may not be as rare as the small number of reported cases might suggest because the adenocarcinoma component may form a very small proportion of the tumor as in our case, and the histopathologic criteria for diagnosis are not clearly established. Thus some cases of adenosquamous carcinoma may not be recognized as such. This underlines the important role of the histopathologist in the diagnosis of oral cancer by the recognition of specific subtypes of cancer and their associated prognostic significance.

Maxillary lymphosarcoma in a cow

Images

Metastatic choriocarcinoma of the maxilla: an unusual cause of severe intractable epistaxis

A fifth case of metastatic choriocarcinoma to the maxilla presenting an intractable epistaxis in a 24-year-old African female, is described.

[Metastasis in maxillary sinus as presentation form of adenocarcinoma of the prostate]

Presentation of one case of prostate adenocarcinoma its initial clinical manifestation being the appearance of facial tumour secondary to metastatic affectation of left maxillar sinus. After stressing its rarity, the relevance of immunohistochemical studies for the specific prostatic antigen and acid phosphatase in determining the unconnected origin of metastatic lesions is addressed.

Signet-ring cell adenocarcinoma metastatic to the maxillary sinus

Signet-ring cell variant is a rare type of adenocarcinoma that has been reported in the paranasal sinuses and in other areas, most commonly the gastrointestinal tract. We describe a patient with signet-ring cell adenocarcinoma of the maxillary sinus who had dental and facial pain. Further evaluation revealed that the lesion was metastatic from an esophageal primary lesion. The unusual nature of this cell type and the importance of careful evaluation to exclude the possibility of these lesions representing metastatic lesions is discussed.

Retinoblastoma metastatic to the contralateral orbit

In a 9-month-old girl a subperiosteal metastasis of the maxillary bone developed in the contralateral orbit about one year after enucleation of a poorly differentiated retinoblastoma.

Metastatic maxillary sinus melanoma treated by local excision and brachytherapy

Malignant melanoma has traditionally been considered a radioresistant tumor. A rare case of metastatic malignant melanoma into the nose and maxillary sinus is presented. Local control was achieved by a combination of local excision and teleradio and brachytherapy. The response of melanomas to radiation treatment is discussed in light of the recent literature.

Malignant melanoma of the maxillary sinus

A 40-year-old white man presented with a mucosal malignant melanoma of the left maxillary sinus two years after removal of a Clark III melanoma of the skin, posterior to the angle of mandible. The symptoms and the successful management of the disease are described.

Squamous cell carcinoma of bladder diverticulum with initial symptoms produced by metastasis to maxillary sinus

A rare case of squamous cell carcinoma in the bladder diverticula of a 74-year-old man with initial clinical symptoms caused by metastasis to the maxillary sinus is reported. The histopathological examination at autopsy confirmed the metastatic squamous cell carcinoma in the maxillary sinus from the bladder diverticula. The vertebral vein plexus seems responsible for this type of metastasis.

Carcinoma of the prostate metastatic to the maxillary antrum

Metastatic carcinoma of the maxillary antrum is an extreme rarity. Until 1980, less than 100 cases with distant primaries metastatic to the entire sinonasal tract had been reported. In a review of these cases, we found no mention of primary prostate cancer metastatic to the antrum. The purpose of this paper is to document the first case of this entity.

Ureteral stump metastases from renal adenocarcinoma

The thirty-second documented case of ureteral stump metastasis from renal adenocarcinoma is presented. It demonstrates well the variable and often unusual presentation of renal adenocarcinoma and the utility of our current diagnostic instrumentation (here ureteroscopy and skinny needle biopsy) in documenting metastatic disease. Also, and in contrast to prior reports, it documents lengthy survival and a lack of extensive metastases in this high risk group of patients. The literature is reviewed and the presentation, metastatic pathways, and management of ureteral stump metastases from renal adenocarcinoma are briefly discussed.

Unusual metastases of renal cell carcinoma

The case of a 55-year-old white male with recurrent metastases in the oral cavity and maxillary sinuses, as well as other organs, is presented. Local excision of the lesions, hormonal treatment and palliative measures for other metastases were used. The patient is alive 10 years after the initial diagnosis.

Gliosarcoma with cranial penetration and extension to the maxillary sinus

A 70 year old woman underwent an anterior rightsided temporal lobectomy for a mixed glioblastoma-fibrosarcoma. Six months later, she presented with rightsided zygomatic and maxillary swellings, associated with rightsided ptosis, chemosis, and nerve palsies of the III, IV, VI, and VII cranial nerves. A computerized scan (CT) of the head revealed tumor erosion of the skull base of the right middle fossa with extension into the maxillary sinus. This was confirmed at surgery. Pathologic examination revealed a predominantly small cell anaplastic glioblastoma associated with sarcoma elements, similar to the original intracranial tumor. This case documents a rare and atypical behavior of malignant glial tumors.

Intracranial meningiomas presenting with epistaxis--case report and literature review

This paper reports a case of the extracranial extension of meningioma from the anterior cranial fossa to the nasal cavity which presented clinically with epistaxis. On rare occasions, the initial manifestation of olfactory groove meningioma is through ENT symptoms. Both the surgical approach and the relevant literature are reviewed.

Metastatic tumours in the maxillary sinus. A report of two cases and a review of the literature

We present two further cases of metastasis in the antrum. A review of the literature reveals renal carcinoma as the commonest primary tumour. When an adenocarcinoma of the antrum is diagnosed, an intravenous pyelogram should be performed to exclude a renal primary. This investigation, if negative, should be repeated during follow-up. The possibility of a bronchial tumour should be investigated in patients with an anaplastic tumour in the antrum.