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
A 54-year-old man with a history of smoking presented with asthenia and acute right cavernous sinus syndrome.
Palsies of right cranial nerves III, IV, VI, and V2, likely caused by intracranial lesions.
Differential diagnoses included clival chondroma, clival chondrosarcoma, intraosseous lymphoma, and meningioma.
Results of routine laboratory tests were normal, apart from a high urinary red blood cell of 14.80/hpf.
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.
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.
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.
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.
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.