Ocular Metastasis as First Presentation of Renal Cell Carcinoma: Report of 2 Cases

Abstract

POMPEU ACL et al. Ocular metastasis as first presentation of renal cell carcinoma: Report of 2 cases. CLINICS 60(1): [75][76][77][78] 2005.Authors report the cases of 2 patients who had an ocular lesion as the first sign leading to diagnosis of renal cell carcinoma, an uncommon presentation of this neoplasm.The first patient was a 59-year-old man presented with a mass in the right eye. The histological and immunohistochemical profile of the biopsy showed a probable renal cell carcinoma. A CT scan showed a solid mass in the left kidney. The patient underwent radical nephrectomy and excision of the ocular lesion and had an uneventful evolution. The second patient was a 72-year-old man presenting with an ulcerated lesion on the right inferior tarsal conjunctiva. An excisional biopsy of the lesion showed histological and immunohistochemical patterns of a clear cell carcinoma. Abdominal tomography disclosed a right peripheral renal tumor. A right radical nephrectomy was performed.Renal cell carcinoma may present atypically with metastases to quite uncommon organs. Nephrectomy may be of value in selected cases; the ocular metastases are usually excised for aesthetic and functional reasons. LETTER TO THE EDITORSRenal cell carcinoma accounts for approximately 85% of primary renal neoplasms, 1 and represents approximately 3% of all adult malignancy. 2 The most common sites of metastasis are lung (50%) and bone (33%), but renal cell carcinoma has been documented to metastasize to every organ and site in the body. Only rarely does it metastasize to the eye and orbit, occasionally mimicking other lesions. Moreover, considering all metastatic neoplasms in the eye, only a minority is due to renal cell carcinoma, as demonstrated in a pathology survey where only 7 out of 196 cases of ocular metastatic carcinoma originated from renal cell carcinomas. 4 Ocular metastases from renal cell carcinomas are most like to involve the iris, 5 ciliary body, 6 and choroids, although eyelid and orbital metastases have been described. 7 Our aim is to report 2 cases of patients who had an ocular lesion as the first sign leading to diagnosis of renal cell carcinoma. CASE 1A 59-year-old man presented to the outpatient ophthalmology department of our hospital in June 2003 with a 3-month history of diplopia and a mass in the right eye. His medical history was significant only for hypertension. Upon examination, a conjunctival lesion and proptosis were found (Figure 1). A CT scan and an ocular ultrasound examination revealed a retroocular mass inferior to the optical nerve. The diagnostic impression on clinical and radiological findings was of a probable metastatic neoplasm. A thoracic CT scan revealed multiple nodular lesions, and an abdominal ultrasound showed a mass in the inferior pole of left kidney and subhepatic lymphadenopathy. The results of complete blood count, electrolytes, liver function tests,

Unusual solitary metastasis of the ciliary body in renal cell carcinoma

“…In a clinicopathologic study of 196 cases of secondary tumors of the choroid, only seven originated from RCC 4,5 . Furthermore, RCC may present atypically at the first diagnosis with metastases to quite uncommon organs, as reported in the two cases of orbital involvement mimicking other lesions and later related to the primary kidney neoplasm 6 . Wizinski et al .…”

“…4,5 Furthermore, RCC may present atypically at the first diagnosis with metastases to quite uncommon organs, as reported in the two cases of orbital involvement mimicking other lesions and later related to the primary kidney neoplasm. 6 Wizinski et al described simultaneous bilateral iris metastases from RCC. 7 A case of spontaneous disappearance of choroidal metastasis from RCC after nephrectomy was described; it was associated to the recognized and rare phenomenon of spontaneous regression of RCC after removal of the primary tumor, estimated to occur in 1-7% cases and possible in every secondary localization.…”

Genitourinary malignancy presenting as an ocular metastasis: A case report and review of the literature

“…20 We identified an additional 6 cases. [22][23][24][25][26] Of these 77 cases, 47% were the primary presentation of malignancy.…”

Conjunctival metastasis of a renal cell carcinoma in a 59-year-old man – clinicopathological case report

“…Five-year survival for disseminated RCC is estimated at less than 10% [2]. The most common metastatic locations of RCC are lungs (76%), regional lymph nodes (66%), bones (42%), liver (41%), and brain (8%) [3,4]. In Poland, about 2500 people die every year from disseminated RCC [5].…”