Case Report
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Sep 6, 2018; 6(9): 301-307
Published online Sep 6, 2018. doi: 10.12998/wjcc.v6.i9.301
Clival metastasis of renal clear cell carcinoma: Case report and literature review
Wei-Qi Zhang, Yue Bao, Bo Qiu, Yong Wang, Zhi-Peng Li, Yi-Bao Wang
Wei-Qi Zhang, Yue Bao, Bo Qiu, Yong Wang, Zhi-Peng Li, Yi-Bao Wang, Department of Neurosurgery, First Affiliated Hospital of China Medical University, Shenyang 110001, Liaoning Province, China
Author contributions: Zhang WQ and Bao Y examined the patient and collected clinical data; Wang YB and Wang Y performed surgical resection and follow up; Zhang WQ and Li ZP wrote the paper; Qiu B and Wang YB edited the manuscript and had final approval.
Institutional review board statement: The authors’ institution does not require IRB approval to publish a single case report.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
Open-Access: This article is an open-access article, which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Yi-Bao Wang, MD, Professor, Department of Neurosurgery, First Affiliated Hospital of China Medical University, Floor # 18, Room # 1801, Shenyang 110001, Liaoning Province, China.
Telephone: +86-24-83283333 Fax: +86-24-83283333
Received: March 31, 2018
Peer-review started: April 2, 2018
First decision: May 24, 2018
Revised: June 1, 2018
Accepted: June 26, 2018
Article in press: June 27, 2018
Published online: September 6, 2018

The clivus is an atypical metastatic site for renal clear cell carcinoma (RCCC). Here we report a 54 year old man with acute cavernous sinus syndrome. Brain magnetic resonance imaging identified a clival-based lesion with associated bony erosion. The patient underwent endoscopic endonasal biopsy and partial resection of the clival mass. Because histologic examination of the resected specimen resulted in a diagnosis of RCCC, contrast-enhanced computed tomography scan of the abdomen was performed and showed an enhanced left renal mass. The patient subsequently underwent laparoscopic left radical nephrectomy and gamma knife was planned for the residual clival lesion. We also retrospectively reviewed available published reports on clival metastases, specifically those from RCCC, since 1990.

Keywords: Clival metastases, Endoscopic skull base surgery, Renal clear cell carcinoma, Renal, Carcinoma

Core tip: Clival metastasis is an extremely rare presentation of renal clear cell carcinoma. The symptom of sudden onset of cranial neuropathy, most commonly involving the abducens nerve, and findings on radiologic examination are crucial for making an early diagnosis. Histopathological diagnosis and resection of the clival mass can be safely achieved through an endoscopic endonasal approach. Multidisciplinary management, including surgery, stereotactic radiotherapy and tumor-targeted agents, is often required to prolong survival and maximize the quality of life for patients with metastatic renal cell carcinoma.