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
Case characteristics

A 54-year-old man with a history of smoking presented with asthenia and acute right cavernous sinus syndrome.

Clinical diagnosis

Palsies of right cranial nerves III, IV, VI, and V2, likely caused by intracranial lesions.

Differential diagnosis

Differential diagnoses included clival chondroma, clival chondrosarcoma, intraosseous lymphoma, and meningioma.

Laboratory diagnosis

Results of routine laboratory tests were normal, apart from a high urinary red blood cell of 14.80/hpf.

Imaging diagnosis

Non-contrast brain magnetic resonance imaging demonstrated a mass lesion in the clivus with irregular margins that had invaded the sphenoid and cavernous sinus bilaterally. Brain computed tomography (CT) scan showed obvious osteolysis of the cranial base involving the clivus and both petrous apexes. Contrast-enhanced CT scan of the abdomen showed a slightly inhomogeneous, enhancing, roundish mass in the upper pole of the left kidney.

Pathological diagnosis

Histopathological examination of the operative specimens revealed clear cells in an alveolar pattern, being separated by a reticular meshwork of thin walled vessels.


Endoscopic endonasal partial resection of the clival metastasis. Laparoscopic left radical nephrectomy of the primary renal clear cell carcinoma (RCCC). Gamma knife for the residual clival lesion.

Related reports

Few reports of clival metastasis from RCCC have been published. These tumors tend to be very aggressive, as evidenced by presentation at an advanced stage of the disease. Multidisciplinary management is necessary.

Term explanation

The Karnofsky Performance Scale is a means of classifying patients’ functional impairment. Scores can be used to compare effectiveness of different therapies and assess the prognosis of individual patients. The lower the Karnofsky score, the worse the prognosis.

Experiences and lessons

Clival metastasis from RCCC should be considered in the differential diagnosis of bony lesions of the clivus in patients with cranial neuropathy of sudden onset. Early diagnosis, clinical experience, and multidisciplinary management are crucial for effective treatment of such lesions.