PMC4835635_01
Sixty two-year-old man with nasal metastasis from silent renal cell carcinoma. A, On nasal endoscopy, a hyperemic and hemorrhagic nasal lesion occupying the right middle meatus was noted; B, Axial CT scan showed an oval-shaped, soft-tissue-density mass in the right ethmoid sinus, extending into the nasal cavity with avid enhancement; C, On MRI, a 2.2 cm, oval-shaped, right sinonasal mass appeared hyperintense on T2WI and isointense on T1WI, with strong enhancement; D, On contrast-enhanced 3D CT images of the kidneys, a heterogeneously enhancing lobulated mass measuring 9.7 x 8.5 cm was found in the upper polar region of the left kidney. Round high-densities represent prominent vascular collaterals. The tumor mass engulfed the left proximal ureter with irregular luminal narrowing (arrowhead).
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On nasal endoscopy, a very hyperemic polypoid mass in the right nasal cavity was noted (Figure 1A). Computed tomography (CT) of the paranasal sinuses revealed an approximately 2.2 cm, oval-shaped, soft-tissue-density mass on the pre-contrast images, with avid enhancement in the right ethmoid sinus and nasal cavity (Figure 1B). T2 weighted imaging (T2WI) and isointense on T1WI, with strong enhancement (Figure 1C). The clinically suspected diagnosis was a hypervascular sinonasal tumor, such as a hemangiopericytoma, hemangioma, or angiofibroma. On contrast-enhanced 3D CT imaging of the kidneys, a heterogeneously enhancing lobulated mass measuring 9.7 x 8.5 cm was found in the upper polar region of the left kidney (Figure 1D).