Published online Sep 6, 2018. doi: 10.12998/wjcc.v6.i9.301
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.
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.