Renal cell carcinoma presenting as epistaxis

Area of Science:

• Oncology
• Pathology
• Nephrology

Background:

• Renal cell carcinoma (RCC) is a kidney malignancy.
• Metastatic presentations of RCC are uncommon.
• Nasal cavity involvement by RCC is exceptionally rare.

Observation:

• A patient presented with a three-week history of epistaxis (nosebleed).
• Nasal biopsy revealed a highly vascular tumor with clear cells, forming glandular structures.
• Cytochemical and ultrastructural analyses showed lipid droplets and glycogen, indicative of renal origin.

Findings:

• Initial investigations including intravenous tomographic pyelography and renal scans were negative for a primary kidney tumor.
• An angiogram successfully identified an intrarenal mass.
• Pathological examination confirmed the intrarenal mass as renal cell carcinoma, establishing the nasal lesion as a metastasis.

Implications:

• This case highlights the importance of considering rare metastatic sites for renal cell carcinoma.
• Diagnostic challenges in identifying primary kidney tumors require advanced imaging techniques like angiography.
• Early detection and accurate diagnosis of metastatic RCC are crucial for patient management.