Letter to the Editor - Metastatic Renal Cell Carcinoma involving Ethmoid Sinus at Presentation

A 57-year-old, normotensive man presented with a one month history of throbbing headache in the right frontal region and three episodes of epistaxis. His otolaryngologic, ophthalmic and systemic examinations were normal. X-ray of paranasal sinuses showed haziness in the right ethmoid region. CT scan of the head showed a soft tissue mass in the right ethmoid region with erosion of the medial wall of the right orbit. Biopsy of the mass on histopathological examination was reported as metastatic clear cell carcinoma. Possibility of primary lesion in the parotid or kidney was suggested. Ultrasonography of the abdomen detected a mixed echogenic mass with irregular and well defined margins and CT scan revealed a non-homogenously enhancing mass at the upper pole of right kidney. CT guided biopsy of the renal mass showed features of clear cell carcinoma. A near total excision of the mass with medial wall of the maxilla , medial orbit and ethmoids via extended Weber-Furguson incision was performed under general anaesthesia. The surgical margins were positive for the tumour. Thus, the patient received post operative radiotherapy. He observed complete relief from symptoms. He refused any surgical procedure for the asymptomatic lesion in his right kidney; thus he was put on hormone therapy (Megestral acetate 300 mg/day). He continues to be in good health and there is no progression of his primary disease or appearance of new metastatic lesions during thirty months post treatment period.