Unusual Spread of Renal Cell Carcinoma to the Clivus with Cranial Nerve Deficit

Jerome Okudo,Nwabundo Anusim

doi:10.1155/2016/9184501

Abstract

Renal cell carcinoma (RCC) has unusual presentation affecting elderly males with a smoking history. The incidence of RCC varies while the incidence of spread of RCC to the clivus is rare. The typicality of RCC presentation includes hematuria, flank pain, and a palpable flank mass; however, RCC can also present with clival metastasis. The unique path of the abducens nerve in the clivus makes it susceptible to damage in metastasis. We report a case of a 54-year-old African American female that was evaluated for back pain, weakness, numbness, and tingling of bilateral lower extremities and subsequently disconjugate gaze and diplopia. Brain MRI confirmed metastasis to the clivus. She was started on radiotherapy and was planned for chemotherapy and transfer to a nursing home. When a patient presents with sudden unusual cranial nerve pathology, the possibility of metastatic RCC should be sought.

Highlights

The involvement of the clivus due to tumor metastasis is a rarity in clinical practice
Metastasis from Renal cell carcinoma (RCC) usually occurs to the lungs in half of the cases; other areas include bone, lymph node, and the brain [3]
Considering the location of the clivus, metastasis to this area can present with multiple cranial nerve pathologies such as diplopia

Summary

Introduction

The involvement of the clivus due to tumor metastasis is a rarity in clinical practice. Very limited literature is available on spread of RCC to the clivus [1, 2]. RCC accounts for less than 5% of all diagnosed malignancies in adults [3]. 25% of RCC are known to have spread at the time at which the diagnosis of malignancy is confirmed [3]. Metastasis from RCC usually occurs to the lungs in half of the cases; other areas include bone, lymph node, and the brain [3]. Cancer spread to the clivus is becoming better known; very few cases of spread from RCC have been reported [1, 3]. Considering the location of the clivus, metastasis to this area can present with multiple cranial nerve pathologies such as diplopia

Case Presentation

Discussion

Findings

Conclusion