Lung adenocarcinoma metastatic to the paranasal sinuses — hypotheses on tumor spread and considerations on the role of radiotherapy

Introduction. Metastases to the paranasal sinuses from primary lung cancer are exceedingly rare and often present with nonspecific symptoms such as epistaxis, facial pain, and nasal congestion. These lesions usually indicate advanced, disseminated disease with poor prognosis. Management is primarily palliative, focusing on symptom relief. Case report. An 82-year-old man presented with recurrent epistaxis and other nonspecific symptoms. Imaging revealed metastatic involvement, among others, of multiple paranasal sinuses characterized by a lepidic-like growth pattern without bone erosion. Biopsy confirmed EGFR -mutated lung adenocarcinoma. Palliative hemostatic radiotherapy was administered to the sinonasal region, achieving rapid bleeding control. EGFR -targeted therapy was initiated, but the patient died shortly thereafter due to systemic progression and renal failure. Conclusions. Paranasal sinus metastases from lung cancer represent an uncommon, late-stage manifestation associated with dismal outcomes. Early recognition and multidisciplinary palliative approaches are crucial. Further molecular research is needed to improve systemic treatments in EGFR -mutated advanced lung adenocarcinoma.