Primary sinonasal renal cell-like adenocarcinoma: a case report and review of the literature
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This case report describes a 69-year-old female with primary sinonasal renal cell-like adenocarcinoma, treated successfully with endoscopic resection, and reviews literature suggesting this is a low-grade carcinoma with a favorable prognosis.
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This paper reports a rare case of primary sinonasal renal cell-like adenocarcinoma (SNRCLA) in a 69-year-old woman presenting with epistaxis and nasal obstruction, alongside a review of previously published English cases. Using CT to exclude metastatic renal cell carcinoma and endonasal endoscopic resection for treatment, the authors describe histology resembling clear cell renal cell carcinoma but without evidence of a renal primary, with immunohistochemistry showing CK7, vimentin, EMA, S-100 positivity and negativity for markers such as CEA and P53, and a low Ki-67 index (5%+). The patient had no recurrence during 27 months of follow-up, and the review notes generally favorable outcomes across reported cases, while also emphasizing diagnostic differential considerations (e.g., hyalinizing clear cell carcinoma, metastatic renal clear cell carcinoma, and other clear cell–appearing head and neck tumors). The paper does not explicitly discuss endometriosis or adenomyosis; it was included in the corpus via a keyword match in the upstream search index.
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Abstract BackgroundPrimary sinonasal renal cell-like adenocarcinoma (SNRCLA) is an extremely rare neoplasm with unique clinical and pathological features. At present, there is no summary of its clinical and pathological characteristics. We treated one case and reported to here. Review the domestic and foreign literature, summarize its clinical pathological characteristics and diagnosis and treatment.CaseA 69-year-old female presented with repeated epistaxis, nasal obstruction of 2-years’ duration. Computed tomography (CT) was performed revealing an irregular mass of the right nasal cavity involving choana and nasopharynx. The patient was treated with endonasal endoscopic resection. Histologically, SNRCLA was very similar to clear cell renal cell carcinoma (RCC), the tumor cells were round or polygonal in size with abundant clear cytoplasm and uniform nuclei. The tumor cells positive for CK7, Vimentin, EMA, S-100, Ki-67 (5% +) and negative for CEA, P53, P63 by immunohistochemical staining,. The patient is free from recurrence over 27 months after the surgery.ConclusionSNRCLA seems to be a low-grade localized carcinoma associated with favorable prognosis. Surgical resection is recommended as the main stay of treatment.
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Primary sinonasal renal cell-like adenocarcinoma: a case report and review of the literature | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Case Report Primary sinonasal renal cell-like adenocarcinoma: a case report and review of the literature Xiaoxia Gou, Yanzhe Wang, Fang Chen, Xiaoli Liu, Peigang Ruan, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-91170/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Primary sinonasal renal cell-like adenocarcinoma (SNRCLA) is an extremely rare neoplasm with unique clinical and pathological features. At present, there is no summary of its clinical and pathological characteristics. We treated one case and reported to here. Review the domestic and foreign literature, summarize its clinical pathological characteristics and diagnosis and treatment. Case A 69-year-old female presented with repeated epistaxis, nasal obstruction of 2-years’ duration. Computed tomography (CT) was performed revealing an irregular mass of the right nasal cavity involving choana and nasopharynx. The patient was treated with endonasal endoscopic resection. Histologically, SNRCLA was very similar to clear cell renal cell carcinoma (RCC), the tumor cells were round or polygonal in size with abundant clear cytoplasm and uniform nuclei. The tumor cells positive for CK7, Vimentin, EMA, S-100, Ki-67 (5% +) and negative for CEA, P53, P63 by immunohistochemical staining,. The patient is free from recurrence over 27 months after the surgery. Conclusion SNRCLA seems to be a low-grade localized carcinoma associated with favorable prognosis. Surgical resection is recommended as the main stay of treatment. Laboratory Diagnostics Pathology sinonasal renal cell-like adenocarcinoma paranasal sinus neoplasm clinical outcome immunohistochemistry surgical resection prognosis Figures Figure 1 Figure 2 Introduction Primary sinonasal renal cell-like adenocarcinoma (SNRCLA) is quite rare and limited number cases reported. “renal-cell like” was originally described by Zur et al[ 1 ] in 2002, who noted its resemblance to the clear-cell type of renal cell carcinoma (RCC) but with no evidence of RCC after a detailed inspection. Herein, we presented a case of primary SNRCLA and described its clinical, histopathologic, immunophenotypic, and prognostic features. Case Report A 69-year-old woman presented with a 2-years history of right-sided epistaxis, she complained of progressive right nasal obstruction without any symptoms such as headaches, tinnitus, diplopia, and numbness of face. Computed tomographic (CT) scan showed an irregular mass in the right nasal extending to the right choana and nasopharynx, no invasive bone destruction (Fig. 1 ). To exclude metastatic RCC, CT scan of abdomen and pelvis were performed, no primary renal tumor was identified. Chest CT and whole-body bone scan using single photon emission computed tomography (SPECT) were normal. The patient treated with endonasal endoscopic resection followed by adjuvant chemotherapy with paclitaxel and cisplatin. Histopathology revealed the tumor consisted of transparent cells arranged in nests and separated by fibrocellular and hyalinized fibrous septa. The nuclei were uniform and small round, with abundant clear cytoplasm, centrally or eccentrically located with inconspicuous nucleoli. Mitosis and necrosis were absent. Immunohistochemica stain revealed the tumor cells positive for cytokeratin (CK), CK5/6, CK7, CK8/18, Vimentin, EMA, S-100, Ki-67 (5% +) and negative for CEA, CgA, Syn, P40, P53, P63, CD34, HMB45, Melan-A, LCA (Fig. 2 ). The radiological, histological, and immunohistochemical foundings were consistent with primary SNRCLA. There was no recurrence over 27 months after aggressive treatment. Discussion SNRCLA is an extremely rare neoplasm, which only 19 cases have been reported in the English literature[ 1 – 19 ]. SNRCLA was first decribed as low grade adenocarcinoma of the nasal cavity and parenasal sinuses by heffner et al[ 2 ]. Later, Moh’d Hadi et al[ 3 ] and Zur et al[ 1 ] found that the tumor cell was very similar to clear cell RCC and no evidence of RCC was identified. Studies have shown that the primary clear cell carcinoma of head and neck may be originated from the salivary gland or the thyroid gland[ 3 ]. They have their unique clinical and pathologic features. In the group of 20 patients, including our present case, have been identified SNRCLA (Table 1 ). The clinical presentation is no difference of other types of nasal neoplasm. The ages of the patients ranged from 22–89 years, with a median age of 62.5 years. There was predominant in women with 13 females and 7 males. The presenting symptom was epistaxis and nasal obstruction in the majority of patients, headache, epiphora, hyposmia and tinnitus were also reported, although not specific for SNRCLA. The primary location were as follows: nasal cavity (11, 55%); Sinonasal (6, 30%), only 3 cases in nasopharynx have been reported. Table 1 Reported cases of sinonasal renal cell-like adenocarcinoma Author Age Gender Location Symptoms Initial diagnosis Metastasis Treatment Follow up Heffner (1982) 2 62 Female Left side of nasal cavity Nasal obstruction and epistaxis Low-grade adenocarcinoma None Resection and radiotherapy Recurred at ≥ 3 years operation, recurred at ≥ 5 years, alive with disease at 7.5 years Moran (1991) 5 67 Male Sinonasal NA Clear cell carcinoma NA NA NA Newman (1993) 4 77 Male Right side of nasal cavity Epistaxis and nasal obstruction Clear cell carcinoma None Resection and radiotherapy Recurrence at ≥ 7 months operation Zur (2002) 1 50 Female Sinonasal Epistaxis, headaches, ocular pressure and epiphora Sinonasal renal cell-like adenocarcinoma None Resection and radiotherapy No recurrence after 8 years Moh'd Hadi (2002) 3 22 Female Olfactory cleft Epistaxis and nasal obstruction Clear cell carcinoma None Resection No recurrence after 4 years Storck (2008) 6 36 Female Nasal cavity Epistaxis Sinonasal renal cell-like adenocarcinoma None Resection and radiotherapy No recurrence after 4 years Storck (2008) 6 69 Male Nasopharynx Epistaxis Sinonasal renal cell-like adenocarcinoma None Radiotherapy and chemotherapy No recurrence after 2 years Cheng (2008) 7 63 Female Nasopharynx Epistaxis, tinnitus and weight loss Clear cell carcinoma None Resection and radiotherapy No recurrence after 12 months Negahban (2009) 8 52 Female Left side of nasal cavity Facial mass and nasal obstruction Clear cell carcinoma NA Resection NA Wang(2010)9 57 Male Nasopharynx Purulence of left ear Clear cell carcinoma None Radiotherapy and chemotherapy No recurrence after 2 months Suzuki (2012) 10 59 Female Sinonasal, skull base and intrarcanial Nasal obstruction and double vision Clear cell carcinoma None Radiotherapy No recurrence after 24 months Brandwein-Gensler (2014) 11 56 Female Nasal cavity, skull base NA Sinonasal renal cell-like adenocarcinoma NA Resection and radiotherapy No recurrence after 22 months Davina (2015) 12 69 Male Sinonasal Epistaxis and nasal obstruction Clear cell carcinoma None Resection No recurrence after 10 months Shen (2015) 13 56 Female Nasal cavity, skull base NA Sinonasal renal cell–like adenocarcinoma None Resection and radiotherapy No recurrence after 22 months Shen (2015) 13 89 Female Sinonasal NA Sinonasal renal cell–like adenocarcinoma None Resection No recurrence after 4 months Shen (2015) 13 73 Male Nasal cavity NA Sinonasal renal cell–like adenocarcinoma None Resection and radiotherapy No recurrence after 20 months Imai (2016) 14 80 Female Right side of nasal cavity Nasal obstruction Clear cell carcinoma None Resection No recurrence after 12 months Kim(2017) 15 63 Male Ethmoid sinus Epistaxis and nasal obstruction Sinonasal renal cell-like adenocarcinoma None Resection and radiotherapy No recurrence after 15 months Wu (2018) 16 26 Female Olfactory cleft Epistaxis, nasal obstruction and hyposmia Sinonasal renal cell-like adenocarcinoma None Resection No recurrence after 2 years Present case 69 Female Nasal cavity Epistaxis and nasal obstruction Sinonasal renal cell-like adenocarcinoma None Resection No recurrence after 27 months NA = not available Histological differential diagnosis that require consideration are hyalinizing clear cell carcinoma (HCCC), squamous cell carcinoma (SCC), metastatic renal clear cell carcinoma (RCCC), mucoepidermoid carcinoma, myoepithelial carcinoma, and epithelial-myoepithelial carcinoma (EMC). Tumor cells of SNRCLA were round or polygonal in size, arranged in a solid nest-like manner, with abundant clear cytoplasm and uniform nuclei, centered or biased on one side, mitosis is rare, rich glycogen and lipoid, clear cell membrane, obvious boundary and slight pleomorphism. As summarized in Table 2 ,most of previously reported SNRCLA case were positive for CK7 (13/14), EMA (8/8), and negative for vimentin (7/13), S100 (9/15). The current case was positive for CK7, vimentin and S100. Most of SNRCLA characteristically expresses CK7, vimentin expression is variable and the Ki-67 proliferation index is usually low. In previous reports, only 9 of the 19 tumors reported to date were initially diagnosed as SNRCLA. About 9 of 19 tumors were initially diagnosed as clear cell carcinoma and 1 of 19 diagnosed a low-grade adenocarcinoma. Table 2 Reported cases of sinonasal renal cell-like adenocarcinoma Author Age Gender CK7 CK20 CD10 EMA CEA Vimentin S100 P63 Heffner (1982) 2 62 Female NA NA NA NA NA NA NA NA Moran (1991) 5 67 Male NA NA NA NA NA NA NA NA Newman (1993 )4 77 Male NA NA NA NA NA NA NA NA Zur (2002) 1 50 Female + - - + + - + NA Moh'd Hadi (2002) 3 22 Female + - - + + - + NA Storck (2008)[36 F] 6 36 Female + + + + + - - NA Storck (2008)[69 f] 6 69 Male + - NA NA NA - - NA Cheng (2008) 7 63 Female NA NA NA NA NA NA NA NA negahban (2009) 8 52 Female + - - + - NA - NA wang(2010) 9 57 Male NA NA NA NA NA NA - NA Suzuki (2012) 10 59 Female - - - + NA + + NA Brandwein-Gensler (2014) 11 56 Female + + NA NA NA + - NA Davina (2015) 12 69 Male + - - + NA - - + Shen (2015) 13 56 Female + + NA NA NA + + NA Shen (2015) 13 89 Female + - NA NA NA - - - Shen (2015) 13 73 Male + - - NA NA + + - imai (2016) 14 80 Female + NA + + NA + - NA Kim(2017) 15 63 Male + - - + + + + NA Wu (2018) 16 26 Female + NA - NA NA - - NA Present case 69 Female + NA NA NA - + + - NA = not available The clinical outcomes of SNRCLA carries a favorable prognosis. 18 patients (including ours) had follow-up examinations, the median follow-up duration was 23 months (range, 2–96 months). 15 patients were treated with primarily surgery, of which 9 patients received adjuvant radiotherapy, 2 patients received radiotherapy and chemotherapy, 1 patient received radiotherapy alone, and 1 patient received chemotherapy alone. Only 2 patients have been local recurrence, 1 patient recurrence at 3 and 5 years after surgical excision[ 2 ], the other patient developed recurrence at 7 months after surgery and postoperative radiotherapy[ 4 ]. Neither regional lymph node involvement nor distant metastases has been documented. The most effective treatment is surgical resection, adjucant radiotherapy may not be necessary in patients with negative margins. In conclusion, we have reported a rare case of primary SNRCLA which is regarded as a low grade tumor. Surgical resection is recommended as the mainstay of treatment, radiotherapy and chemotherapy are still controversial. Further studies on clinical information, radiology, cytology, and immunohistochemistry is helpful for diagnosing SNRCLA. Abbreviations SNRCLA Primary sinonasal renal cell-like adenocarcinoma CT Computed tomography RCC Renal cell carcinoma SPECT Single photon emission computed tomography HCCC hyalinizing clear cell carcinoma SCC Squamous cell carcinoma RCCC Renal clear cell carcinoma EMC Eepithelial-myoepithelial carcinoma Declarations Acknowledgments This work was supported by Master’s Initial Fund of Affiliated Hospital of Zunyi Medical University (No.YZ[2011]10), Huichuan District Science and Technology Bureau Funding of Zunyi (fzl120171106). Authors’contributions Xiaoxia Gou and Yanzhe Wang did the literature search, study design, data analysis, interpretation of results and drafted the main manuscript. Fang Chen and Xiaoli Liu and Peigang Ruan and Xin Tian and Jinzhi Wu reviewed patients file charts and did the follow up of cases. Xiaoxia Gou and Hu Ma did critically review and approval of final manuscript. The author(s) read and approved the final manuscript. Funding Master’s Initial Fund of Affiliated Hospital of Zunyi Medical University (No.YZ[2011]10) and Huichuan District Science and Technology Bureau Funding of Zunyi (fzl120171106） Availability of data and materials All data generated or analyzed during this study are included in this published article. Consent for publication Informed consent was obtained from the patient. Competing interests The authors declare that they have no competing interests. Consent for publication Not applicable. References Zur KB, Brandwein M, Wang B, Som P, Gordon R, Urken ML, Primary Description of a New Entity, Renal Cell-Like Carcinoma of the Nasal Cavity: Van Meegeren in the House of Vermeer, Archives of otolaryngology–head & neck surgery , 128 (2002), 441-7. Heffner DK, Hyams VJ, Hauck KW, Lingeman C, Low-Grade Adenocarcinoma of the Nasal Cavity and Paranasal Sinuses, Cancer , 50 (1982), 312 – 22. Moh'd Hadi U, Kahwaji GJ, Mufarrij AA, Tawil A, Noureddine B, Low Grade Primary Clear Cell Carcinoma of the Sinonasal Tract, Rhinology , 40 (2002), 44 – 7. Newman JP, Funkhouser WK. Pathologic quiz case 1. Clear cell carcinoma of the nasal cavity. Arch Otolaryngol Head Neck Surg. 1993;119:1046–9. Moran CA, Wenig BM, Mullick FG. Primary Adenocarcinoma of the Nasal Cavity and Paranasal Sinuses, Ear, nose, & throat journal , 70 (1991), 821–8. Storck K, Hadi UM, Simpson R, Ramer M, Brandwein-Gensler M. Sinonasal Renal Cell-Like Adenocarcinoma: A Report on Four Patients. Head Neck Pathol. 2008;2:75–80. Cheng LH, Lin YS, Lee JC. Primary Clear Cell Carcinoma of the Nasopharynx. Otolaryngol Head Neck Surg. 2008;139:592–3. Negahban S, Daneshbod Y, Khademi B, Rasekhi AR, Soleimanpour H. Sinonasal Clear Cell Adenocarcinoma: A Case Report. Acta cytologica. 2009;53:597–600. Wang F, Fu Z. Primary Clear Cell Carcinoma of the Nasopharynx: A Case Report. The Chinese-German Journal of Clinical Oncology. 2010;9:493–94. Suzuki K, Wanibuchi M, Akiyama Y, et al. Primary Clear Cell Carcinoma of the Skull Base and Paranasal Cavity: A Case Report, No shinkei geka . Neurological surgery. 2012;40:617–21. Brandwein-Gensler M, Wei S. Envisioning the Next Who Head and Neck Classification. Head Neck Pathol. 2014;8:1–15. Davina ST, Linda L, Abdul Razak A, Vijayaprakas Rao R, Norkamaruzaman E. Primary Sinonasal Clear Cell Carcinoma: Case Report. Med J Malay. 2015;70:112–3. Tiansheng Shen Q, Shi C, Velosa S, Bai L, Thompson R, Simpson, Shi Wei, and Margaret Brandwein-Gensler.Sinonasal Renal Cell–Like Adenocarcinomas: Robust Carbonic Anhydrase Expression, Human Pathology , 46 (2015), 1598 – 606. Imai T, Satoh I, Matsumoto K, Ito S, Asada Y, Kato K, Koshiba Y, Saijo S, Matsuura KClear Cell Carcinoma of the Nasal Cavity: A Case Report from Histopathological Viewpoint, Auris, nasus, larynx , 43 (2016), 108 – 11. Kim NI, Yang JI, Kim SS, Lee JS, Lim SC, Jung S, Lee JH, Moon KS, Lee KH. Sinonasal Renal Cell-Like Adenocarcinoma, a Unique Variant of Primary Clear Cell Carcinoma of the Head and Neck: The First Reported Case in Korea, Medicine , 96 (2017), e7711. Wu CN, Chuang IC, Chuang MJ, Chen WC. Sinonasal Renal Cell-Like Adenocarcinoma: Easily Misdiagnosed Sinonasal Tumor, Head & neck , 40 (2018), E91-E95. AlAli BM, Alyousef MJ, Kamel AS, Al Hamad MA, Al-Bar MH, Algowiez RM. Primary Paranasal Sinus Hyalinizing Clear Cell Carcinoma: A Case Report. Diagn Pathol. 2017;12:70. Jui Lan SC, Huang Y-H, Chen W-C, Chen Y-T, Jin Y-C, Lu. Chih-Yen Chien, and Hsuan-Ying Huang.Primary Paranasal Sinus Clear Cell Carcinoma with Ewsr1-Atf1 Fusion: Report of 2 Molecularly Confirmed Cases Exhibiting Unique Histopathology. Hum Pathol. 2017;63:139–43. Shah AA, LeGallo RD, van Zante A, Frierson HF Jr, Mills SE, Berean KW, Mentrikoski MJ. and E. B. Stelow.Ewsr1 Genetic Rearrangements in Salivary Gland Tumors: A Specific and Very Common Feature of Hyalinizing Clear Cell Carcinoma. Am J Surg Pathol. 2013;37:571–8. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-91170","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Case Report","associatedPublications":[],"authors":[{"id":3412891,"identity":"92c5957c-99f9-4bf2-a3c9-65ae70a64294","order_by":0,"name":"Xiaoxia Gou","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA4UlEQVRIiWNgGAWjYLCCBwz/5fjlDx848OEHsVoSGJiNJWewJR6c2UOClkSDGzzGhznYiFDNP7v94oOEGrYEg9s9Hw4z8DDI84sdwK9F4s6ZYoOEYzx5knfObjhcYMFgOHN2AgFrbuSkSSSwSRTzHcjdcHgGDwPQOgJa5G/kpP9I+GeQ2HAg58FhHjYitBjcSD/GkNiWkDjhRg4DcVoMb+QwSyT2HTCW7DlmAAxkCcJ+kbuR/vDDh28H5PjZmx9/+PDDRp5fmoAWBgYeA2SeBCHlIMD+gBhVo2AUjIJRMJIBAOcPTh7JeKDLAAAAAElFTkSuQmCC","orcid":"https://orcid.org/0000-0002-3842-4007","institution":"The Second Affiliated Hospital of Zunyi Medical University","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Xiaoxia","middleName":"","lastName":"Gou","suffix":""},{"id":3412892,"identity":"98b76430-0308-452b-a777-718916b1bd97","order_by":1,"name":"Yanzhe Wang","email":"","orcid":"","institution":"The Second Affiliated Hospital of Zunyi Medical University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Yanzhe","middleName":"","lastName":"Wang","suffix":""},{"id":3412893,"identity":"1a598616-6f0c-43a9-9083-1699e9b239df","order_by":2,"name":"Fang Chen","email":"","orcid":"","institution":"Cancer Liboratory Affiliated of Zunyi Medical University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Fang","middleName":"","lastName":"Chen","suffix":""},{"id":3412894,"identity":"ec79beb4-fef3-4249-b093-a34fc0b6fd42","order_by":3,"name":"Xiaoli Liu","email":"","orcid":"","institution":"The first Affiliated Hospital of Zunyi","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Xiaoli","middleName":"","lastName":"Liu","suffix":""},{"id":3412895,"identity":"3cf19e8f-f02d-46d6-a1c3-494210c1e3c1","order_by":4,"name":"Peigang Ruan","email":"","orcid":"","institution":"The Second Affiliated Hospital of Zunyi Medical University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Peigang","middleName":"","lastName":"Ruan","suffix":""},{"id":3412896,"identity":"60bd8db7-bd18-416f-a5f0-a72708f60cd9","order_by":5,"name":"Xin Tian","email":"","orcid":"","institution":"The Second Affiliated Hospital of Zunyi Medical University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Xin","middleName":"","lastName":"Tian","suffix":""},{"id":3412897,"identity":"d274477e-9d35-4cc3-a0c4-fec7e3b6e4f6","order_by":6,"name":"Jinzhi Wu","email":"","orcid":"","institution":"The Second Affiliated Hospital of Zunyi Medical University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Jinzhi","middleName":"","lastName":"Wu","suffix":""},{"id":3412898,"identity":"f9c1a8e9-4dd3-4e01-adec-ca5fe239379d","order_by":7,"name":"Hu Ma","email":"","orcid":"","institution":"The Second Affiliated Hospital of Zunyi Medical University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Hu","middleName":"","lastName":"Ma","suffix":""}],"badges":[],"createdAt":"2020-10-11 22:49:04","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-91170/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-91170/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":3057861,"identity":"e23d2812-1a3f-452e-a21d-9c73989d515f","added_by":"auto","created_at":"2020-10-19 13:43:53","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":74081,"visible":true,"origin":"","legend":"Head CT scan. CT scan shows a soft tissue mass filling the right nasal and extends posteriorly to the choana in soft tissue window (A) and bone window (B). CT = computed tomography.","description":"","filename":"renamed71a23.jpg","url":"https://assets-eu.researchsquare.com/files/rs-91170/v1/818c76cd180e7c29185e1154.jpg"},{"id":3057862,"identity":"d183ffe5-8450-4385-b0d4-636f68b0ed6d","added_by":"auto","created_at":"2020-10-19 13:43:53","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":205794,"visible":true,"origin":"","legend":"Features of tumor cells. The tumor consisted of transparent cells arranged in nests and separated by fibrocellular and hyalinized fibrous septa. Tumor cells were shown to have abundant clear cytoplasm, small round nuclei, and distinct cytoplasmic borders. (A, B, H\u0026E stain, original magnification ×100 and ×400 respectively). Immunohistochemistry revealed strong positivity for CK7 in tumor cells. (C, D, immunohistochemistry, original magnification ×100, and ×400, respectively). H\u0026E = hematoxylin-and-eosin. ","description":"","filename":"renamed17887.jpg","url":"https://assets-eu.researchsquare.com/files/rs-91170/v1/45f54f985b2226160c2d3564.jpg"},{"id":13604205,"identity":"113f4036-c192-4e26-9de9-ed837d9e9d13","added_by":"auto","created_at":"2021-09-17 05:58:53","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":543108,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-91170/v1/b0fdb691-986c-499c-aa5d-520008af004a.pdf"}],"financialInterests":"","formattedTitle":"Primary sinonasal renal cell-like adenocarcinoma: a case report and review of the literature","fulltext":[{"header":"Introduction","content":" \u003cp\u003ePrimary sinonasal renal cell-like adenocarcinoma (SNRCLA) is quite rare and limited number cases reported. \u0026ldquo;renal-cell like\u0026rdquo; was originally described by Zur et al[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e] in 2002, who noted its resemblance to the clear-cell type of renal cell carcinoma (RCC) but with no evidence of RCC after a detailed inspection. Herein, we presented a case of primary SNRCLA and described its clinical, histopathologic, immunophenotypic, and prognostic features.\u003c/p\u003e "},{"header":"Case Report","content":" \u003cp\u003eA 69-year-old woman presented with a 2-years history of right-sided epistaxis, she complained of progressive right nasal obstruction without any symptoms such as headaches, tinnitus, diplopia, and numbness of face. Computed tomographic (CT) scan showed an irregular mass in the right nasal extending to the right choana and nasopharynx, no invasive bone destruction (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). To exclude metastatic RCC, CT scan of abdomen and pelvis were performed, no primary renal tumor was identified. Chest CT and whole-body bone scan using single photon emission computed tomography (SPECT) were normal. The patient treated with endonasal endoscopic resection followed by adjuvant chemotherapy with paclitaxel and cisplatin. Histopathology revealed the tumor consisted of transparent cells arranged in nests and separated by fibrocellular and hyalinized fibrous septa. The nuclei were uniform and small round, with abundant clear cytoplasm, centrally or eccentrically located with inconspicuous nucleoli. Mitosis and necrosis were absent. Immunohistochemica stain revealed the tumor cells positive for cytokeratin (CK), CK5/6, CK7, CK8/18, Vimentin, EMA, S-100, Ki-67 (5% +) and negative for CEA, CgA, Syn, P40, P53, P63, CD34, HMB45, Melan-A, LCA (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). The radiological, histological, and immunohistochemical foundings were consistent with primary SNRCLA. There was no recurrence over 27\u0026nbsp;months after aggressive treatment.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e "},{"header":"Discussion","content":" \u003cp\u003eSNRCLA is an extremely rare neoplasm, which only 19 cases have been reported in the English literature[\u003cspan additionalcitationids=\"CR2 CR3 CR4 CR5 CR6 CR7 CR8 CR9 CR10 CR11 CR12 CR13 CR14 CR15 CR16 CR17 CR18\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. SNRCLA was first decribed as low grade adenocarcinoma of the nasal cavity and parenasal sinuses by heffner et al[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Later, Moh\u0026rsquo;d Hadi et al[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e] and Zur et al[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e] found that the tumor cell was very similar to clear cell RCC and no evidence of RCC was identified. Studies have shown that the primary clear cell carcinoma of head and neck may be originated from the salivary gland or the thyroid gland[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. They have their unique clinical and pathologic features.\u003c/p\u003e \u003cp\u003eIn the group of 20 patients, including our present case, have been identified SNRCLA (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). The clinical presentation is no difference of other types of nasal neoplasm. The ages of the patients ranged from 22\u0026ndash;89 years, with a median age of 62.5\u0026nbsp;years. There was predominant in women with 13 females and 7 males. The presenting symptom was epistaxis and nasal obstruction in the majority of patients, headache, epiphora, hyposmia and tinnitus were also reported, although not specific for SNRCLA. The primary location were as follows: nasal cavity (11, 55%); Sinonasal (6, 30%), only 3 cases in nasopharynx have been reported.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eReported cases of sinonasal renal cell-like adenocarcinoma\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"9\"\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAuthor\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eLocation\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eSymptoms\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eInitial diagnosis\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eMetastasis\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eTreatment\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003eFollow up\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHeffner (1982)\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eLeft side of nasal cavity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNasal obstruction and epistaxis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eLow-grade adenocarcinoma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eNone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eResection and radiotherapy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eRecurred at \u0026ge;\u0026thinsp;3\u0026nbsp;years operation, recurred at \u0026ge;\u0026thinsp;5 years, alive with disease at 7.5\u0026nbsp;years\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMoran (1991)\u003csup\u003e5\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSinonasal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eClear cell carcinoma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNewman (1993)\u003csup\u003e4\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eRight side of nasal cavity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eEpistaxis and nasal obstruction\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eClear cell carcinoma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eNone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eResection and radiotherapy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eRecurrence at \u0026ge;\u0026thinsp;7 months operation\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eZur (2002)\u003csup\u003e1\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSinonasal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eEpistaxis, headaches, ocular pressure and epiphora\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eSinonasal renal cell-like\u003c/p\u003e \u003cp\u003eadenocarcinoma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eNone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eResection and radiotherapy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eNo recurrence after 8\u0026nbsp;years\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMoh'd Hadi (2002)\u003csup\u003e3\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eOlfactory cleft\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eEpistaxis and nasal obstruction\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eClear cell carcinoma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eNone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eResection\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eNo recurrence after 4\u0026nbsp;years\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStorck (2008)\u003csup\u003e6\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNasal cavity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eEpistaxis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eSinonasal renal cell-like\u003c/p\u003e \u003cp\u003eadenocarcinoma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eNone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eResection and radiotherapy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eNo recurrence after 4\u0026nbsp;years\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStorck (2008)\u003csup\u003e6\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e69\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNasopharynx\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eEpistaxis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eSinonasal renal cell-like\u003c/p\u003e \u003cp\u003eadenocarcinoma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eNone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eRadiotherapy and chemotherapy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eNo recurrence after 2\u0026nbsp;years\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCheng (2008)\u003csup\u003e7\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNasopharynx\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eEpistaxis, tinnitus and weight loss\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eClear cell carcinoma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eNone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eResection and radiotherapy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eNo recurrence after 12 months\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNegahban (2009)\u003csup\u003e8\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eLeft side of nasal cavity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eFacial mass and nasal obstruction\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eClear cell carcinoma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eResection\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWang(2010)9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNasopharynx\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ePurulence of left ear\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eClear cell carcinoma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eNone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eRadiotherapy and chemotherapy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eNo recurrence after 2 months\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSuzuki (2012)\u003csup\u003e10\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSinonasal, skull base and intrarcanial\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNasal obstruction and double vision\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eClear cell carcinoma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eNone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eRadiotherapy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eNo recurrence after 24 months\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBrandwein-Gensler (2014)\u003csup\u003e11\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNasal cavity, skull base\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eSinonasal renal cell-like adenocarcinoma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eResection and radiotherapy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eNo recurrence after 22 months\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDavina (2015)\u003csup\u003e12\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e69\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSinonasal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eEpistaxis and nasal obstruction\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eClear cell carcinoma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eNone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eResection\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eNo recurrence after 10 months\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eShen (2015)\u003csup\u003e13\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNasal cavity, skull base\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eSinonasal renal cell\u0026ndash;like adenocarcinoma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eNone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eResection and radiotherapy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eNo recurrence after 22 months\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eShen (2015)\u003csup\u003e13\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSinonasal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eSinonasal renal cell\u0026ndash;like adenocarcinoma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eNone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eResection\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eNo recurrence after 4 months\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eShen (2015)\u003csup\u003e13\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNasal cavity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eSinonasal renal cell\u0026ndash;like adenocarcinoma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eNone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eResection and radiotherapy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eNo recurrence after 20 months\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eImai (2016)\u003csup\u003e14\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eRight side of nasal cavity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNasal obstruction\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eClear cell carcinoma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eNone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eResection\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eNo recurrence after 12 months\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eKim(2017)\u003csup\u003e15\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eEthmoid sinus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eEpistaxis and nasal obstruction\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eSinonasal renal cell-like adenocarcinoma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eNone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eResection and radiotherapy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eNo recurrence after 15 months\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWu (2018)\u003csup\u003e16\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eOlfactory cleft\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eEpistaxis, nasal obstruction and hyposmia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eSinonasal renal cell-like\u003c/p\u003e \u003cp\u003eadenocarcinoma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eNone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eResection\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eNo recurrence after 2\u0026nbsp;years\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePresent case\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e69\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNasal cavity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eEpistaxis and nasal obstruction\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eSinonasal renal cell-like\u003c/p\u003e \u003cp\u003eadenocarcinoma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eNone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eResection\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eNo recurrence after 27 months\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNA\u0026thinsp;=\u0026thinsp;not available\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eHistological differential diagnosis that require consideration are hyalinizing clear cell carcinoma (HCCC), squamous cell carcinoma (SCC), metastatic renal clear cell carcinoma (RCCC), mucoepidermoid carcinoma, myoepithelial carcinoma, and epithelial-myoepithelial carcinoma (EMC). Tumor cells of SNRCLA were round or polygonal in size, arranged in a solid nest-like manner, with abundant clear cytoplasm and uniform nuclei, centered or biased on one side, mitosis is rare, rich glycogen and lipoid, clear cell membrane, obvious boundary and slight pleomorphism. As summarized in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e,most of previously reported SNRCLA case were positive for CK7 (13/14), EMA (8/8), and negative for vimentin (7/13), S100 (9/15). The current case was positive for CK7, vimentin and S100. Most of SNRCLA characteristically expresses CK7, vimentin expression is variable and the Ki-67 proliferation index is usually low. In previous reports, only 9 of the 19 tumors reported to date were initially diagnosed as SNRCLA. About 9 of 19 tumors were initially diagnosed as clear cell carcinoma and 1 of 19 diagnosed a low-grade adenocarcinoma.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eReported cases of sinonasal renal cell-like adenocarcinoma\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"11\"\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAuthor\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCK7\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eCK20\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eCD10\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eEMA\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eCEA\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003eVimentin\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c10\"\u003e \u003cp\u003eS100\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c11\"\u003e \u003cp\u003eP63\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHeffner (1982)\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMoran (1991)\u003csup\u003e5\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNewman (1993\u003csup\u003e)4\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eZur (2002)\u003csup\u003e1\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e+\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e+\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e+\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e+\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMoh'd Hadi (2002)\u003csup\u003e3\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e+\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e+\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e+\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e+\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStorck (2008)[36 F]\u003csup\u003e6\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e+\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e+\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e+\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e+\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e+\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStorck (2008)[69 f] \u003csup\u003e6\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e69\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e+\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCheng (2008)\u003csup\u003e7\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003enegahban (2009)\u003csup\u003e8\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e+\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e+\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ewang(2010)\u003csup\u003e9\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSuzuki (2012)\u003csup\u003e10\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e+\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e+\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e+\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBrandwein-Gensler (2014)\u003csup\u003e11\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e+\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e+\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e+\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDavina (2015)\u003csup\u003e12\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e69\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e+\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e+\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e+\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eShen (2015)\u003csup\u003e13\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e+\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e+\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e+\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e+\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eShen (2015)\u003csup\u003e13\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e+\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eShen (2015)\u003csup\u003e13\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e+\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e+\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e+\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eimai (2016)\u003csup\u003e14\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e+\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e+\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e+\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e+\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eKim(2017)\u003csup\u003e15\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e+\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e+\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e+\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e+\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e+\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWu (2018)\u003csup\u003e16\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e+\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePresent case\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e69\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e+\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e+\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e+\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNA\u0026thinsp;=\u0026thinsp;not available\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe clinical outcomes of SNRCLA carries a favorable prognosis. 18 patients (including ours) had follow-up examinations, the median follow-up duration was 23\u0026nbsp;months (range, 2\u0026ndash;96\u0026nbsp;months). 15 patients were treated with primarily surgery, of which 9 patients received adjuvant radiotherapy, 2 patients received radiotherapy and chemotherapy, 1 patient received radiotherapy alone, and 1 patient received chemotherapy alone. Only 2 patients have been local recurrence, 1 patient recurrence at 3 and 5\u0026nbsp;years after surgical excision[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e], the other patient developed recurrence at 7\u0026nbsp;months after surgery and postoperative radiotherapy[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Neither regional lymph node involvement nor distant metastases has been documented. The most effective treatment is surgical resection, adjucant radiotherapy may not be necessary in patients with negative margins.\u003c/p\u003e \u003cp\u003eIn conclusion, we have reported a rare case of primary SNRCLA which is regarded as a low grade tumor. Surgical resection is recommended as the mainstay of treatment, radiotherapy and chemotherapy are still controversial. Further studies on clinical information, radiology, cytology, and immunohistochemistry is helpful for diagnosing SNRCLA.\u003c/p\u003e "},{"header":"Abbreviations","content":" \u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eSNRCLA\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ePrimary sinonasal renal cell-like adenocarcinoma\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCT\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eComputed tomography\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eRCC\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eRenal cell carcinoma\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eSPECT\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eSingle photon emission computed tomography\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eHCCC\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ehyalinizing clear cell carcinoma\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eSCC\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eSquamous cell carcinoma\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eRCCC\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eRenal clear cell carcinoma\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eEMC\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eEepithelial-myoepithelial carcinoma\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e "},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis work was supported by Master\u0026rsquo;s Initial Fund of Affiliated Hospital of Zunyi Medical University (No.YZ[2011]10), Huichuan District Science and Technology Bureau Funding of Zunyi (fzl120171106).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo;contributions \u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eXiaoxia Gou and Yanzhe Wang did the literature search, study design, data analysis, interpretation of results and drafted the main manuscript. Fang Chen and Xiaoli Liu and Peigang Ruan and Xin Tian and Jinzhi Wu reviewed patients file charts and did the follow up of cases. Xiaoxia Gou and Hu Ma did critically review and approval of final manuscript. The author(s) read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMaster\u0026rsquo;s Initial Fund of Affiliated Hospital of Zunyi Medical University (No.YZ[2011]10) and Huichuan District Science and Technology Bureau Funding of Zunyi (fzl120171106）\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials \u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll data generated or analyzed during this study are included in this published article.\u003c/p\u003e\n\u003ch3\u003eConsent for publication\u003c/h3\u003e\n\u003cp\u003eInformed consent was obtained from the patient.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests \u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eZur KB, Brandwein M, Wang B, Som P, Gordon R, Urken ML, Primary Description of a New Entity, Renal Cell-Like Carcinoma of the Nasal Cavity: Van Meegeren in the House of Vermeer, \u003cem\u003eArchives of otolaryngology\u0026ndash;head \u0026amp; neck surgery\u003c/em\u003e, 128 (2002), 441-7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHeffner DK, Hyams VJ, Hauck KW, Lingeman C, Low-Grade Adenocarcinoma of the Nasal Cavity and Paranasal Sinuses, \u003cem\u003eCancer\u003c/em\u003e, 50 (1982), 312 \u0026ndash; 22.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMoh'd Hadi U, Kahwaji GJ, Mufarrij AA, Tawil A, Noureddine B, Low Grade Primary Clear Cell Carcinoma of the Sinonasal Tract, \u003cem\u003eRhinology\u003c/em\u003e, 40 (2002), 44 \u0026ndash; 7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNewman JP, Funkhouser WK. 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Med J Malay. 2015;70:112\u0026ndash;3.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTiansheng Shen Q, Shi C, Velosa S, Bai L, Thompson R, Simpson, Shi Wei, and Margaret Brandwein-Gensler.Sinonasal Renal Cell\u0026ndash;Like Adenocarcinomas: Robust Carbonic Anhydrase Expression, \u003cem\u003eHuman Pathology\u003c/em\u003e, 46 (2015), 1598 \u0026ndash; 606.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eImai T, Satoh I, Matsumoto K, Ito S, Asada Y, Kato K, Koshiba Y, Saijo S, Matsuura KClear Cell Carcinoma of the Nasal Cavity: A Case Report from Histopathological Viewpoint, \u003cem\u003eAuris, nasus, larynx\u003c/em\u003e, 43 (2016), 108 \u0026ndash; 11.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKim NI, Yang JI, Kim SS, Lee JS, Lim SC, Jung S, Lee JH, Moon KS, Lee KH. Sinonasal Renal Cell-Like Adenocarcinoma, a Unique Variant of Primary Clear Cell Carcinoma of the Head and Neck: The First Reported Case in Korea, \u003cem\u003eMedicine\u003c/em\u003e, 96 (2017), e7711.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWu CN, Chuang IC, Chuang MJ, Chen WC. Sinonasal Renal Cell-Like Adenocarcinoma: Easily Misdiagnosed Sinonasal Tumor, \u003cem\u003eHead \u0026amp; neck\u003c/em\u003e, 40 (2018), E91-E95.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAlAli BM, Alyousef MJ, Kamel AS, Al Hamad MA, Al-Bar MH, Algowiez RM. Primary Paranasal Sinus Hyalinizing Clear Cell Carcinoma: A Case Report. Diagn Pathol. 2017;12:70.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJui Lan SC, Huang Y-H, Chen W-C, Chen Y-T, Jin Y-C, Lu. Chih-Yen Chien, and Hsuan-Ying Huang.Primary Paranasal Sinus Clear Cell Carcinoma with Ewsr1-Atf1 Fusion: Report of 2 Molecularly Confirmed Cases Exhibiting Unique Histopathology. Hum Pathol. 2017;63:139\u0026ndash;43.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eShah AA, LeGallo RD, van Zante A, Frierson HF Jr, Mills SE, Berean KW, Mentrikoski MJ. and E. B. Stelow.Ewsr1 Genetic Rearrangements in Salivary Gland Tumors: A Specific and Very Common Feature of Hyalinizing Clear Cell Carcinoma. Am J Surg Pathol. 2013;37:571\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"sinonasal renal cell-like adenocarcinoma, paranasal sinus neoplasm, clinical outcome, immunohistochemistry, surgical resection, prognosis","lastPublishedDoi":"10.21203/rs.3.rs-91170/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-91170/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e\u003c/p\u003e\u003cp\u003ePrimary sinonasal renal cell-like adenocarcinoma (SNRCLA) is an extremely rare neoplasm with unique clinical and pathological features. At present, there is no summary of its clinical and pathological characteristics. We treated one case and reported to here. Review the domestic and foreign literature, summarize its clinical pathological characteristics and diagnosis and treatment.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eCase\u003c/strong\u003e\u003c/p\u003e\u003cp\u003eA 69-year-old female presented with repeated epistaxis, nasal obstruction of 2-years’ duration. Computed tomography (CT) was performed revealing an irregular mass of the right nasal cavity involving choana and nasopharynx. The patient was treated with endonasal endoscopic resection. Histologically, SNRCLA was very similar to clear cell renal cell carcinoma (RCC), the tumor cells were round or polygonal in size with abundant clear cytoplasm and uniform nuclei. The tumor cells positive for CK7, Vimentin, EMA, S-100, Ki-67 (5% +) and negative for CEA, P53, P63 by immunohistochemical staining,. The patient is free from recurrence over 27 months after the surgery.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e\u003c/p\u003e\u003cp\u003eSNRCLA seems to be a low-grade localized carcinoma associated with favorable prognosis. Surgical resection is recommended as the main stay of treatment.\u0026nbsp;\u003c/p\u003e","manuscriptTitle":"Primary sinonasal renal cell-like adenocarcinoma: a case report and review of the literature","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2020-10-19 13:43:52","doi":"10.21203/rs.3.rs-91170/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"7ab3e917-85c1-4261-9311-d166140aac19","owner":[],"postedDate":"October 19th, 2020","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":813662,"name":"Laboratory Diagnostics"},{"id":813663,"name":"Pathology"}],"tags":[],"updatedAt":"2020-10-20T22:22:53+00:00","versionOfRecord":[],"versionCreatedAt":"2020-10-19 13:43:52","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-91170","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-91170","identity":"rs-91170","version":["v1"]},"buildId":"cBFmMYwuxLRRLfASyISRj","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}
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