PARADOXICAL SPREAD OF RENAL-CELL CARCINOMA TO THE HEAD AND NECK

Objectives: To present cases of renal cell carcinoma presenting with o nly head and neck metastases, to review theories of physiology and ana tomy describing this phenomenon, and to discuss the role of the otolar yngologist in the treatment of these lesions. Study Design: Retrospect ive review of the records of three patients who presented with renal c ell carcinoma with head and neck metastases over the 3-year period hom 1992 to 1995, Methods: Retrospective review of the records of three p atients who presented with renal cell carcinoma with head and neck met astases, In addition, English-language literature was reviewed with sp ecial focus on the anatomic and physiologic pathways possible to allow for such a phenomenon. Conclusions: Renal cell carcinoma has an occas ional presentation as a head and neck mass without evidence of disease elsewhere. Various routes of spread have been postulated. Batson's ve nous plexus, as postulated by Nahum and Bailey,(2) is an anatomic rout e through which emboli could navigate to the head and neck and avoid p ulmonary vascular filtration, Interactions on the cellular level may a lso be responsible for the seemingly paradoxical spread. We recommend local excision of head and neck metastases of renal cell carcinoma wit hout sacrifice of vital structures as a sound treatment regimen.