Metastatic Renal Cell Carcinoma Mimicking Trigeminal Schwannoma in a Patient Presenting with Trigeminal Neuralgia

Arthur Wang; George Kleinman; Raj Murali; John Wainwright; Adesh Tandon

doi:10.1055/s-0035-1566125

Journal of Neurological Surgery Reports, Table of Contents

J Neurol Surg Rep 2015; 76(02): e282-e286
DOI: 10.1055/s-0035-1566125

Case Report

Georg Thieme Verlag KG Stuttgart · New York

Metastatic Renal Cell Carcinoma Mimicking Trigeminal Schwannoma in a Patient Presenting with Trigeminal Neuralgia

Authors

Arthur Wang

¹Department of Neurosurgery, New York Medical College, Westchester, Valhalla, New York, United States
George Kleinman

²Department of Pathology, New York Medical College, Westchester, Valhalla, New York, United States
Raj Murali

¹Department of Neurosurgery, New York Medical College, Westchester, Valhalla, New York, United States
John Wainwright

¹Department of Neurosurgery, New York Medical College, Westchester, Valhalla, New York, United States
Adesh Tandon

¹Department of Neurosurgery, New York Medical College, Westchester, Valhalla, New York, United States

Abstract

We present an unusual case of a metastatic renal cell carcinoma (RCC) mimicking trigeminal schwannoma. The patient, with no prior history of RCC, presented with clinical symptoms and imaging consistent with trigeminal neuralgia secondary to trigeminal schwannoma. Magnetic resonance imaging of the brain showed a large bilobed cystic/solid mass primarily in the cerebellopontine angle cistern, with extension into the left middle cranial fossa, Meckel cave, and left cavernous sinus. Following surgical excision, histopathology revealed the tumor to be an RCC infiltrating into the trigeminal nerve fascicles. Further imaging and investigation revealed widespread metastasis to the vertebral bodies and long bones. Metastatic RCC to the trigeminal nerve is rare. Despite the development of more effective treatment modalities, the prognosis of metastatic RCC remains poor. To our knowledge, this is the first reported case of RCC metastasizing to the trigeminal nerve fascicles.

Keywords

metastatic renal cancer - renal cell carcinoma - trigeminal schwannoma - trigeminal neuralgia - cerebellopontine angle

Full Text

References

References
1 Lalwani AK. Meningiomas, epidermoids, and other nonacoustic tumors of the cerebellopontine angle. Otolaryngol Clin North Am 1992; 25 (3) 707-728
2 Bhatoe HS, Deshpande GU. Cerebellopontine angle metastasis from clear-cell renal carcinoma presenting as bleeding from the ear. J Laryngol Otol 1996; 110 (4) 370-372
3 Bennani O, Derrey S, Langlois O , et al. Brain metastasis from renal cell carcinoma. Neurochirurgie 2014; 60 (1–2) 12-16
4 Panarese A, Turner J, Fagan PA. Renal carcinoma metastasis: an unusual cerebellopontine angle tumor. Otolaryngol Head Neck Surg 2002; 127 (3) 245-247
5 Sepúlveda I, Platin E, Klaassen R , et al. Skull base clear cell carcinoma, metastasis of renal primary tumor: a case report and literature review. Case Rep Oncol 2013; 6 (2) 416-423
6 Hill Jr KL, Lipson AC, Sheehan JM. Brain magnetic resonance imaging changes after sorafenib and sunitinib chemotherapy in patients with advanced renal cell and breast carcinoma. J Neurosurg 2009; 111 (3) 497-503
7 Endo K, Okano R, Kuroda Y, Yamada S, Tabei K. Renal cell carcinoma with skull base metastasis preceded by paraneoplastic signs in a chronic hemodialysis patient. Intern Med 2001; 40 (9) 924-930
8 De Pena CA, Lee YY, Van Tassel P. Lymphomatous involvement of the trigeminal nerve and Meckel cave: CT and MR appearance. AJNR Am J Neuroradiol 1989; 10 (5, Suppl): S15-S17
9 Nakano I, Iwasaki K, Kondo A. Solitary metastatic breast carcinoma in a trigeminal nerve mimicking a trigeminal neurinoma. Case report. J Neurosurg 1996; 85 (4) 677-680
10 Kotecha R, Angelov L, Barnett GH , et al. Calvarial and skull base metastases: expanding the clinical utility of Gamma Knife surgery. J Neurosurg 2014; 121 (Suppl): 91-101
11 Payne BR, Prasad D, Szeifert G, Steiner M, Steiner L. Gamma surgery for intracranial metastases from renal cell carcinoma. J Neurosurg 2000; 92 (5) 760-765
12 Brener ZZ, Zhuravenko I, Jacob CE, Bergman M. An unusual presentation of renal cell carcinoma with late metastases to the small intestine, thyroid gland, nose and skull base. Nephrol Dial Transplant 2007; 22 (3) 930-932
13 Mendelson ZS, Patel AA, Eloy JA, Liu JK. Endoscopic palliative decompression of the cavernous sinus in a rare case of a metastatic renal cell carcinoma to the clivus. Br J Neurosurg 2015; 29 (3) 430-431
14 Parida PK. Renal cell carcinoma metastatic to the sinonasal region: three case reports with a review of the literature. Ear Nose Throat J 2012; 91 (11) E11-E16
15 Remenschneider AK, Sadow PM, Lin DT, Gray ST. Metastatic renal cell carcinoma to the sinonasal cavity: a case series. J Neurol Surg Rep 2013; 74 (2) 67-72
16 Streitmann MJ, Sismanis A. Metastatic carcinoma of the temporal bone. Am J Otol 1996; 17 (5) 780-783
17 Mubaidin SI, Sunna JB, Beiruti MA, Shennak MM, Ayoub MS. Renal cell carcinoma presenting as Garcin's syndrome. J Neurol Neurosurg Psychiatry 1990; 53 (7) 613-614
18 Chamoun RB, Suki D, DeMonte F. Surgical management of cranial base metastases. Neurosurgery 2012; 70 (4) 802-809 ; discussion 809–810
19 Kim CH, Chung SK, Dhong HJ, Lee JI. Cerebrospinal fluid leakage after gamma knife radiosurgery for skull base metastasis from renal cell carcinoma: a case report. Laryngoscope 2008; 118 (11) 1925-1927
20 Maxwell M, Borges LF, Zervas NT. Renal cell carcinoma: a rare source of cauda equina metastasis. Case report. J Neurosurg 1999; 90 (1, Suppl): 129-132
21 Shuto T, Inomori S, Fujino H, Nagano H. Gamma knife surgery for metastatic brain tumors from renal cell carcinoma. J Neurosurg 2006; 105 (4) 555-560