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Abstract
Renal cell carcinoma (RCC) is a rare malignancy characterized by a variety of clinical features. It represents approximately 3 % of all adult malignancies and ranks 13th in frequency of all carcinomas.[1,2] RCC has been documented to metastasize to every organ in the body although metastasis to the eye and orbit is uncommon. Metastases may present decades after the removal of the primary disease. However, it is uncommon for patients who present with ocular metastasis before primary RCC is identified. We report a rare and unique case of metastatic renal cell carcinoma presenting as a choroidal mass despite no evidence of a primary tumour.
We present a case of a 65-year-old Chinese man who had sought treatment for a right-sided painful blind eye for 2 years which progressively worsened over time. His vision was poor since the age of 15 years and he was unsure of the cause. Initially, he was treated for the painful blind eye secondary to glaucoma and went for evisceration. Intraoperatively, we noticed that his vitreous cavity was filled with hard fibrotic mass. Histopathological examination was reported as right eye metastatic renal cell carcinoma with clear cell variant. Further investigation was done and he underwent exenteration in view of right optic nerve bulkiness which was also related to renal cell carcinoma. Interestingly, no tumour marker was positive and computed tomography (CT) thorax, abdomen and pelvis did not reveal any primary tumour. He did not complain of any adverse urinary symptoms and there were no signs and symptoms to suggest a concurrent renal pathology.
We report a rare and unique case of metastatic renal cell carcinoma presenting as a choroidal mass as the first presenting sign without evidence of primary tumour. Differential diagnosis of metastases must be considered in patients who present with an ocular mass, despite being asymptomatic of any primary malignancy. This is to ensure that this condition is promptly identified and treatment initiated as soon as possible. By highlighting this case, we seek to bring awareness to this condition and hopefully improve on its current dismal prognosis by early diagnosis.
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References
- Pompeu ACL, Arap S, Silva MNR, et al. Ocular metastasis as first presentation of renal cell carcinoma: report of 2 cases. Clinics (São Paulo) 2005;60(1):75-8.
- Bellerive C, Allaire G, Callejo S. A late onset of choroidal metastasis from renal cell carcinoma simulating melanoma. Can J Ophthalmol 2017;52(3):e108-10.
- Ferry AP, Font RL. Carcinoma metastatic to the eye and orbit: I. a clinicopathologic study of 227 cases. Arch Ophthalmol 1974;92(4):276-86.
- Wyzinski P, Rootman J. Simultaneous bilateral iris metastases from renal cell carcinoma. Am J Ophthalmol 1981;92(2):206-9.
- Kindermann WR, Shields JA, Eiferman RA, et al. Metastatic renal cell carcinoma to the eye and adnexae: a report of three cases and review of the literature. Ophthalmology 1981;88(12):1347-50.
- Haimovici R, Gragoudas ES, Gregor Z, et al. Choroidal metastases from renal cell carcinoma. Ophthalmology 1997;104(7):1152-8.
- Williamson ZC, Arepalli SR, Shields CL. Vitreous haemorrhage as the initial sign of renal cell carcinoma metastasis. Retina Today 2014:38-40.
- Kurli M, Finger PT. The kidney, cancer, and the eye: current concepts. Surv Ophthalmol 2005;50(6):507-18.
- Shields CL, Shields JA, Gross NE, et al. Survey of 520 eyes with uveal metastases. Ophthalmology 1997;104(8):1265-76.
- Featherstone JM, Bass P, Cumming J, et al. Solitary, late metastatic recurrence of renal cell carcinoma: two extraordinary cases. Int J Urol 2006;13(12):1525-7.
- Komanski CB, Rubino SM, Meyer JC, et al. Choroidal melanoma mimicker: a case of metastatic clear-cell renal cell carcinoma. Ocul Oncol Pathol 2017;3(4):279-82.
- Shome D, Honavar SG, Gupta P, et al. Metastasis to the eye and orbit from renal cell carcinoma--a report of three cases and review of literature. Surv Ophthalmol 2007;52(2):213-23.
References
Pompeu ACL, Arap S, Silva MNR, et al. Ocular metastasis as first presentation of renal cell carcinoma: report of 2 cases. Clinics (São Paulo) 2005;60(1):75-8.
Bellerive C, Allaire G, Callejo S. A late onset of choroidal metastasis from renal cell carcinoma simulating melanoma. Can J Ophthalmol 2017;52(3):e108-10.
Ferry AP, Font RL. Carcinoma metastatic to the eye and orbit: I. a clinicopathologic study of 227 cases. Arch Ophthalmol 1974;92(4):276-86.
Wyzinski P, Rootman J. Simultaneous bilateral iris metastases from renal cell carcinoma. Am J Ophthalmol 1981;92(2):206-9.
Kindermann WR, Shields JA, Eiferman RA, et al. Metastatic renal cell carcinoma to the eye and adnexae: a report of three cases and review of the literature. Ophthalmology 1981;88(12):1347-50.
Haimovici R, Gragoudas ES, Gregor Z, et al. Choroidal metastases from renal cell carcinoma. Ophthalmology 1997;104(7):1152-8.
Williamson ZC, Arepalli SR, Shields CL. Vitreous haemorrhage as the initial sign of renal cell carcinoma metastasis. Retina Today 2014:38-40.
Kurli M, Finger PT. The kidney, cancer, and the eye: current concepts. Surv Ophthalmol 2005;50(6):507-18.
Shields CL, Shields JA, Gross NE, et al. Survey of 520 eyes with uveal metastases. Ophthalmology 1997;104(8):1265-76.
Featherstone JM, Bass P, Cumming J, et al. Solitary, late metastatic recurrence of renal cell carcinoma: two extraordinary cases. Int J Urol 2006;13(12):1525-7.
Komanski CB, Rubino SM, Meyer JC, et al. Choroidal melanoma mimicker: a case of metastatic clear-cell renal cell carcinoma. Ocul Oncol Pathol 2017;3(4):279-82.
Shome D, Honavar SG, Gupta P, et al. Metastasis to the eye and orbit from renal cell carcinoma--a report of three cases and review of literature. Surv Ophthalmol 2007;52(2):213-23.