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Laryngorhinootologie 2015; 94(11): 745-748
DOI: 10.1055/s-0034-1395571
Originalie
© Georg Thieme Verlag KG Stuttgart · New York

Extranodale Metastasen von Nierenzellkarzinomen in der Kopf-Hals-Region

Extranodal Metastases of Renal Cell Carcinoma to the Head and Neck: A Diagnostic Challenge
A. M. Franzen
1   HNO – Plastische Operationen, Ruppiner Kliniken, Neuruppin
,
C. Schneider
2   Onkologischer Schwerpunkt, Ruppiner Kliniken, Neuruppin
,
S. Lebentrau
3   Klinik für Urologie und Kinderurologie, Ruppiner Kliniken, Neuruppin
,
T. Günzel
4   HNO-Abteilung, Borromäus-Hospital, Leer, Ostfriesland
› Author Affiliations
Further Information

Publication History

eingereicht 17 October 2014

akzeptiert 02 November 2014

Publication Date:
19 January 2015 (online)

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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
 

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