Clinical and Endoscopic Findings
Even though signs and symptoms of secondary tumors of the sinonasal tract do not differ from those of primary lesions, some peculiarities may be worth mentioning. The diagnosis of a sinonasal metastasis is often delayed, and in some cases it is recognized even years after the primary tumor (Simo et al. 2000). Conversely, a metastasis may be the first presentation of a tumor otherwise clinically silent for a long period (Altman et al. 1997; Cama et al. 2002). Of course, the presence of a sinonasal mass in a patient already treated for a malignancy should always arouse the suspect of a secondary lesion. Since renal cell carcinoma is a highly vascularized tumor, epistaxis is the most frequent complaint. In these lesions, nasal bleeding may be catastrophic, thence surgeons should be aware of the risk of complications linked to simple procedures such as a biopsy under local anesthesia.
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