An unusual presentation of a metastatic hypernephroma to the frontonasal region

We report a rare case involving an 85-year-old man who presented with a large metastatic hypernephroma to the frontal sinuses, the base of the nose, and the ethmoid sinuses, disfiguring the patient's face. Frequent but intermittent and mild epistaxis was one of the main symptoms. He had no history of renal malignancy, and even at the time of our examination (18 months after the appearance of the facial tumor) he did not have any symptoms of the primary renal carcinoma (not even hematuria). This metastasis may have occurred through the vertebral plexus of veins that communicate with the great venous plexus of the head and the plexus of the paranasal sinuses. If a metastatic hypernephroma to the sinonasal tract is the only clinical metastasis, as in our patient, a radical excision of the solitary metastasis, together with a nephrectomy, is recommended. Physicians dealing with head and neck lesions should always suspect a metastatic tumor and especially, a hypernephroma.