A 62-year-old woman presents with severe recurrent epistaxis and a dark red, friable, haemorrhagic mass in the right nasal cavity. Contrast CT shows an intensely enhancing vascular lesion in the ethmoid region. She underwent nephrectomy for a renal mass five years ago. The most likely diagnosis is:

• A Sinonasal melanoma
• B Metastatic renal cell carcinoma ✓
• C Lobular capillary haemangioma
• D Olfactory neuroblastoma

Explanation

Renal cell carcinoma is the most frequent primary to metastasise to the nose and paranasal sinuses, characteristically presenting years after the renal primary with brisk epistaxis and an intensely hypervascular mass. Lobular capillary haemangioma occurs in pregnant women on the anterior septum and lacks the history of renal malignancy. Melanoma is pigmented mucosal disease, and olfactory neuroblastoma is a small round blue cell tumour, neither of which matches the vascular enhancing pattern here.

Reference: Robbins and Cotran Pathologic Basis of Disease, 10th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.