Extranodale Metastasen von Nierenzellkarzinomen in der Kopf-Hals-Region

Zusammenfassung

Hintergrund: In Einzelfallmitteilungen wird regelmäßig über Metastasen von Nierenzellkarzinomen (NCC) in extranodalen Lokalisationen der Kopf-Hals-Region (KHR) und ungewöhnliche klinische Verläufe berichtet. In der vorgelegten Untersuchung soll die tatsächliche diagnostische Relevanz metastatischer NCC für den HNO-Arzt auf der Basis einer systematischen Untersuchung ermittelt werden.

Methoden: Retrospektive Untersuchung von 612 NCC, die in einem Zeitraum von 13 Jahren in der Klinik für Urologie behandelt wurden.

Ergebnisse: Von 612 Patienten waren insgesamt 191 (31%) metastasiert, bei 3 Frauen und 4 Männern (Durchschnittsalter 66,8a, 56a–78a) fanden wir extranodale Metastasen in der KHR. Betroffen waren Glandula parotis und thyroidea (2 ×), Zunge, Stirnhaut, Schädelknochen und Nasennebenhöhlen. Die Metastasen wurden im Durchschnitt 40,8 (5–87) Monate nach dem Primarius diagnostiziert. Bei einer Patientin war die Metastase in der Parotis die einzige Manifestation eines 78 Monate zuvor therapierten NCC, bei den übrigen wurden zeitgleich weitere infraklavikuläre Metastasen gefunden.

Diskussion: Nach unseren Ergebnissen sind extranodale Metastasen von NCC in der KHR selten (1,1%). Die ungewöhnliche Lokalisation der Metastasen und der klinische Verlauf stellen eine diagnostische und differenzialdiagnostische Herausforderung für Kliniker und Pathologen dar – die große Bedeutung einer umfassenden onkologischen Anamnese wird bestätigt. Obwohl eine exklusive Metastasierung in die KHR nach unseren Ergebnissen selten ist, spielt die Metastasenchirurgie sowohl im Rahmen kurativer als auch symptomatischer Therapiekonzepte eine Rolle.

Abstract

Background: Single case reports about extranodal renal cell carcinoma (RCC) metastasis to the head and neck (HN) often implicating unusual clinical follow-ups are well known. Subject of our investigation is to ascertain the true meaning of RCC for differential diagnostic of the head and neck surgion.

Methods: We retrospectively review the reports of 612 patients with RCC treated in a 13-years period in the department of urology.

Results: Of the 612 RCC 191 (31%) were metastatic, 3 female and 4 male (mean 66.8a, 56a–78a) presented with extranodal metastases within the HN. Extranodal locations were parotid and thyroid glands (2 ×), tongue, forehead scin, bone and paranasal sinus. Occurrence of metastases were observed in mean 40.8 months (5–87) after the primary. In one patient metastasis to the parotid gland was the only manifestation of RCC 78 month treated before, the others presented with further metastases to infraclavicular organs.

Discussion: According to our results extranodal metastases of RCC to the HN are uncommon (1.1%). Therefore and because of the unusual location extranodal metastases of RCC remain a diagnostic challenge for the ENT specialist and the pathologist with peculiar knowledge of the oncological history of the patient remaining an essential condition. We found exclusive metastasis to the HN in only one of 7 cases. Nevertheless surgical treatment has to be considered in curative and symptomatic treatment strategies.

Schlüsselwörter

Nierenzellkarzinom - Metastasen - extranodal - Kopf-Hals-Region - Diagnostik - Therapie

Key words

renal cell carcinoma - metastases - extra nodal metastasis - head and neck - diagnosis - therapy

• Literatur

• 1 Alvarez-Mugica M, Bulnes Vazquez M, Jalon Monzon A, Rodriguez Robles L, Miranda Aranzubia O. Late recurrence from a renal cell carcinoma: solitary right maxillar mass 17 years after surgery. Arch Esp Urol 2010; 63: 147-50
• 2 Deeb R, Zhang Z, Kini S, Ghanen T. Metastatic renal cell carcinoma to the parotid gland presenting 19 years after nephrectomy: case report and review of the literature. Laryngoscope 2010; 120: 128
• 3 Gnepp DR. Secondary Tumors. In: Ellies GL, Auclair PL. Tumors of the salivary glands. Armed Forces Institute of Pathologie. Washington D.C: Chapt; 8. 2008: 471-479
• 4 Gottlieb MD, Roland JT. Paradoxical spread of renal cell carcinoma to the head and neck. Laryngoscope 1998; 108: 1301-1305
• 5 Kundu S, Eynon-Lewis NJ, Radcliffe GJ. Extensive renal cell carcinoma presenting as facial nerve palsy. J Laryngol Otol 2001; 115: 488-490
• 6 Langille G, Taylor SM, Bullock MJ. Metastatic renal cell carcinoma to the head and neck: summary of 21 cases. Otolaryngol Head Neck Surg 2008; 37: 515-521
• 7 Özkiris M, Kubilay U, Ozan SS. Cervical lymph node metastasis in renal cell carcinoma. J Oral Pathol 2011; 15: 211-213
• 8 Park YW, Hlivo TJ. Parotid gland metastasis from renal cell carcinoma. Laryngoscope 2002; 112: 453-456
• 9 Pritchyk KM, Schiff BA, Newkirk KA, Krowiak E, Deeb Z. Metastatic renal cell carcinoma to the head and neck. Laryngoscope 2002; 112: 1598-1602
• 10 Sabo R, Sela M, Herskovitz P, Feinmesser R. Metastatic hypernephroma to the head and neck: unusual case reports and review of the literature. J Otolaryngol 2001; 30: 140-144
• 11 Spreafico R, Nicoletti G, Ferrario F, Scanziani R, Grasso M. Parotid metastasis from renal cell carcinoma: a case report and review of the literature. Acta Otolaryngol Ital 2008; 28: 266-268
• 12 Torres Carranza E, Garcia Perla A, Infante-Cossio P, Belmonte-Caro R, Loizaga-Iriondo JM, Gutierrez-Perez JL. Airway obstruction due to metastatic renal cell carcinoma to the tongue. Oral Surg Oral Med Oral Pathol oral Radiol Endod 2006; 101: e76-e78
• 13 Simo R, Sykes AJ, Hargreaves AP, Axon PR, Birzgalis AR, Slevin NJ, Farrington WT. Metastatic renal cell carcinoma to the nose and the paranasel sinuses. Head Neck 2000; 22: 722-727
• 14 Serouya SM, Dultz LA, Concors SJ, Wang B, Patel KN. Late solitary metastasis of renal cell carcinoma to the submandibular gland. J Oral Maxillofac Surg 2012; 70: 2356-2359
• 15 Seifert G, Hennings K, Caselitz J. Metastatic tumors of the parotid and submandibular gland. Path Res Pract 1986; 181: 684-692
• 16 Mrena R, Leivo Z, Passador-Santos F, Hagström J, Mäkitie AA. Histopathological findings in parotid gland metastasis from renal cell carcinoma. Eur Arch Otorhinolaryngol 2008; 265: 1005-1009
• 17 Heffess CSW, Wenig BM, Thompson LD. Metastatic renal cell carcinoma to the thyroid gland: a clinopathologic study of 36 cases. Cancer 2002; 95: 1869-1878
• 18 Iesalnieks I, Winter H, Bareck E, Sotiropoulos GC, Goretzki PE, Klinkhammer-Schalke M, Bröckner S, Trupka A, Anthuber M, Rupprecht H, Raab M, Meyer W, Reichmann F, Kästel M, Mayr M, Braun W, Schlitt HJ, Agha A. Thyroid metastases of renal cell carcinoma: clinical course in 45 patients undergoing surgery. Assessment of factors affecting patients’survival. Thyroid 2008; 18: 615-624
• 19 Mc Kean ME, Lee K, Gregor IA. The distribution of lymph nodes in and around the parotid gland: An anatomical study. Br J Plast Surg 1985; 38: 1-5
• 20 Döme B, Hendrix MJ, Paku S, Tóvári J, Tímár J. Alternative vascularization mechanisms in cancer: Pathology and therapeutic implications. The American journal of pathology 2007; 170: 1-15
• 21 Kroeger N, Seligson DB, Klatte T, Rampersaud EN, Birkhäuser FD, Rao PN, Leppert JT, Zomorodian N, Kabbinavar FF, Belldegrun AS, Pantuck AJ. Clinical, molecular, and genetic correlates of lymphatic spread in clear cell renal cell carcinoma. European Urology 2012; 61: 888-895
• 22 Liungberg B, Cowan NC, Hanbury DC, Hora M, Kuczyk MA, Merseburger AS, Patard JJ, Mulders PF, Sinescu IC. European Association of Urology Guideline Group . EAU guidelines onrenal cell carcinoma: the 2010 update. Eur Urol 2010; 58: 398-406
• 23 Issing PR, Stöver T, Kempf HG, Heermann R, Lenarz T. Sonographic diagnosis of metastatic renal cell carcinoma to the head and neck region. Ultraschall Med 1999; 20: 218-222
• 24 Firek P, Richter S, Jaeckel J, Brehmer B, Heidenreich A. Metastasectomy in renal cell cancer after neoadjuvant therapy with multi-tyrosine kinase inhibitors. Urologe A 2012; 51: 398-402
• 25 Assouad J, Petkova B, Berna P, Dujon A, Foucault C, Riquet M. Renal cell carcinoma lung metastases surgery: pathologic findings and prognostic factors. An Thorac Surg 2007; 84: 1114-1120
• 26 Pfannschmidt J, Klode J, Muley T, Dienemann H, Hoffmann H. Nodal involvement at the time of pulmonary metastasectomy: experiences in 245 patients. An Thorac Surg 2006; 81: 448-454
• 27 Staehler MD, Kruse J, Haseke N, Stadler T, Roosen A, Karl A, Stief CG, Jauch KW, Bruns CJ. Liver resection for metastatic disease prolongs survival in renal cell carcinoma: 12-year results from a retrospective comparative analysis. World J Urol 2010; 28: 543-547