Trigeminal Ganglion Metastasis of Renal Clear Cell Carcinoma: Cases Report and Review of the Literature.

ABSTRACT

BACKGROUND: The trigeminal ganglion is an atypical site for metastasis, especially for renal clear cell carcinoma. CASE DESCRIPTION We report 2 clinical cases of a 66-year-old man and a 58-year-old man with trigeminal symptoms. Both patients had a history of renal clear cell (RCC) that was considered to be cured at 6 and 9 years, respectively. Brain magnetic resonance imaging (MRI) showed a trigeminal ganglion lesion with increased gadolinium enhancement associated with petrous apex erosion. The main diagnostic hypothesis based on MRI was trigeminal schwannoma for both patients. One patient underwent subtotal removal, the other a biopsy. Histologic examinations resulted in the diagnosis of RCC metastasis. Body computed tomography revealed pancreatic metastasis for both but no renal recurrence. The patients were treated by local radiotherapy, and 1 of the patients had associated chemotherapy. We added to these clinical cases a literature review of skull base metastasis of RCC. Trigeminal ganglion metastasis of RCC is very rare and can persist until 10 years after the first RCC diagnosis. It seems that the best treatment is surgical removal. To date, the role of local radiotherapy is not demonstrated, and the prognosis seems to be poor. CONCLUSIONS: In the case of trigeminal symptoms, rapid tumoral growth on brain MRI, or a history of RCC, we think that a body computed tomography should be performed, and surgery should be considered.