Skull Base Clear Cell Carcinoma, Metastasis of Renal Primary Tumor: A Case Report and Literature Review
We report on a 62-year-old male who presented to the Ophthalmology Service with VI cranial nerve bilateral paresis, absence of pharyngeal reflex, dysarthria, right tongue deviation, and paralysis to the right side of the face. CT and MRI were performed, with CT showing a large expansive process at the cranial base with clivus and right petrous apex osteolysis (fig. ). Poor enhancement was seen following intravenous contrast injection associated with rhinopharyngeal involvement (fig. ).\nAn MRI T1 sequence showed a solid isointense expansive process with bilateral internal carotid artery involvement (fig. ). An MRI T2 sequence revealed small hyperintense areas indicative of being cystic in nature or suggestive of central necrosis (fig. ). Ipsilateral side secretions coming from the Eustachian tube indicated the mastoid region had been compromised. An additional MRI T1 sequence following administration of gadolinium contrast material showed moderate enhancement with clear involvement of bilateral internal carotid arteries (fig. ) and the cavernous sinus, posterior ethmoidal sinus, clivus and both petrous apex infiltration. In addition, nasal and posterior superior rhinopharyngeal wall involvement was observed (fig. ).\nAfter imaging analysis, the patient was referred to the ENT service and a biopsy was performed. The diagnosis was clear cell adenocarcinoma and suspicion of renal tumor metastases. The Head and Neck Cancer Committee recommended ultrasonography, which subsequently revealed a heterogeneous echogenic multilobular mass on the right kidney, with irregular contours (fig. , fig. , fig. ).\nPelvic and abdominal CT was performed, revealing a large mass on the right kidney with irregular contours and poor definition. Further investigations performed following contrast injection revealed a heterogeneous density with a hypodense central area and some calcifications in thickness (hyperdense deposits in the body of the primary tumor: right kidney) (fig. ). Radiotherapy was recommended, but due to the advanced stage of the disease the patient was enrolled in a palliative care and pain control program.