Sinonasal Metastasis: A Clinicopathological Series of Seven Cases

Abstract

Introduction: Metastases to the sinonasal region is rare and presents with features overlapping with various regional neoplastic/non-neoplastic lesions. This series aims to highlight the clinical presentations and diagnostic difficulties of sinonasal metastases. Material and Method: A review of pertinent demographic and laboratory data for patients diagnosed with metastases to the sinonasal region, over a period of 6 years (2012- 2017) was done. Results and Discussion: Seven cases (males- 6, females-1) of sinonasal metastases were identified. The age ranged from 41-72 years. The common clinical presentation was nasal obstruction, epistaxis, and pain. Grossly tumors were irregular masses (mean size – 4.1cm) with maxillary sinus as the most common site. The histologic types included Squamous cell carcinoma (3 cases), clear cell renal cell carcinoma (2 cases), and one case each of infiltrating ductal carcinoma, and eccrine spiradenocarcinoma. The site of the primary tumor was larynx (2/7), kidney (2/7), breast (1/7), lung (1/7), and neck (1/7). The mean time interval between the primary tumor and metastasis was 4.5 months. All cases were managed with resection of the metastatic tumor. Metastatic breast and renal tumors comprise the bulk of reported cases in English literature. Metastasis from a lung carcinoma are rare and here we report the first case of an eccrine spiradenocarcinoma to maxillary sinus. Conclusions: Owing to the overlapping clinical presentations, a high degree of suspicion is needed in patients with previous history of malignancy for early diagnosis. The current course of therapy is palliative for such patients and carries a grim prognosis.

Keywords

• metastasis
• nasal obstruction
• renal cell carcinoma
• lung carcinoma
• eccrine spiradenocarcinoma