An Uncommon Sinonasal Metastasis: Case report
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A woman in her 30s with no relevant medical history was referred for a progressive bilateral nasal airway obstruction. Endoscopic examination found a voluminous, pulsatile, highly vascularized mass in both nasal cavities. Enhanced (CT) scan showed a hypervascular tumor in the nasal cavity, on the left thyroid, the fifth rib, and the L4 vertebra. Biologic examinations revealed a significant elevation of serum thyroglobulin (4432 ng/mL). MRI confirmed a hypervascular tumor with anterior skull base extension (contrast enhancement after gadolinium injection, intermediate T2 signal).

After a multidisciplinary meeting, and considering the rich vascularization of the nasal tumor, a first-line radiography-guided costal biopsy was performed. The anatomopathologic examination pointed to VTC metastasis, and thyroidectomy was performed (minimally invasive VTC). Radioiodine whole-body scintigraphy found considerable uptake regarding rib and vertebral lesions. However, the sinonasal tumor had low uptake, indicative of thyroid tissue with low iodine.

During etiologic investigation of the sinonasal tumor, the patient's symptoms quickly worsened, with nasal bleeding and decreased vision in the left eye due to prechiasmatic extrinsic compression of the optic nerves. Given persistent doubt concerning the anatomopathologic diagnosis of the sinonasal tumor, a biopsy was performed after embolization of the sphenopalatine and facial arteries. Histopathologic examination of the sinonasal tumor confirmed VTC metastasis. Considering the patient’s refractory response to iodine therapy, systemic treatment with lenvatinib was initiated (24 mg per day).

A CT scan performed 4 months after treatment initiation found good regression of the nasal lesion without further metastasis. However, the nasal lesion remained inoperable.