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Secondary Tumors 9.8.1

Definition, Epidemiology, Pattern of Growth

Metastasis to nose and paranasal sinuses is an exceedingly rare occurrence, with approximately 100 cases reported in the literature (Pignataro et al.

2001). The highest incidence is in the sixth decade in men and the seventh decade in women (Izquierdo et al. 2000), which probably reflects the incidence of primary tumors.

Different pathogenetic mechanisms have been put forward to explain this exceptional event: hematoge-nous dissemination through the vertebral and epidu-ral valveless venous plexus (Batson 1995); neoplastic embolization (Nahum and Bailey 1963); spreading through hematic or lymphatic vessels (Gottlieb and Roland 1998; Simo et al. 2000).

More than 50% of sinonasal metastases take origin from a renal carcinoma (Simo et al. 2000; Pignataro et al. 2001). In up to 16% of patients with renal cell carcinoma, metastases are located above the clavicles (Simo et al. 2000). However, an isolated head and neck metastasis is very rare, occurring in only 1% of all renal cell carcinomas (Simo et al. 2000).

Less frequent malignant lesions metastasizing to the sinonasal area include thyroid gland (Freeman et al. 1996; Altman et al. 1997), larynx (Morales-Angulo et al. 1994), breast (Pignataro et al. 2001; Pitkaranta et al. 2001), lung (Clarkson et al.

2002), liver (Izquierdo et al. 2000), stomach (Owa et al. 1995), colon (Cama et al. 2002), urinary blad der (Kawai et al. 1989), ovary (Campisi and Cheski 1998), and prostate carcinoma (Saleh 1996).

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