Vision Loss from Choroidal and Pituitary Metastases Secondary to Renal Cell Carcinoma: A Case Report

Abstract

A 62-year-old male with a history of metastatic clear cell renal cell carcinoma (ccRCC) presented with decreased vision to 20/50 in the left eye. Fundus examination revealed an elevated, amelanotic mass lesion in the superotemporal macula, without involvement of the central macula by subretinal fluid or tumour. Given incongruity between the fundus findings and the degree of visual impairment, visual field testing was obtained, revealing a bitemporal hemianopia. Magnetic resonance imaging demonstrated optic chiasm compression by a pituitary mass, which had previously been overlooked on computed tomography imaging. Biopsy confirmed metastatic ccRCC to the pituitary, which presented simultaneously with the presumed choroidal metastasis.

Renal Cell Carcinoma Metastasis to Anterior Orbit

“…Therefore, diagnosis of RCC should be suspected in patients presenting with a mass in the eyelid with a previous history of RCC, even if the patient presumes to be in remission. This was seen with the patient presented in this case and in another case where the patient was in remission of RCC for 20 years [3,4]. It has been reported that RCC metastasis to the eye can be the first presenting sign of RCC leading to a diagnosis of RCC in patients [1,2].…”

“…One study showed that only 3-7% of such masses were from the metastasis of tumors, with the majority of such tumors could be attributed to tumor metastases from the breast in women and lung and prostate in men [ 2 ]. The most common presenting ocular symptoms of ophthalmic tumors are proptosis or diplopia followed by ptosis, enophthalmos, pain, and decreased visual acuity [ 2 , 3 ]. RCC is a rare systemic malignancy comprising 2-4% of all tumors [ 2 , 3 ].…”

“…The most common presenting ocular symptoms of ophthalmic tumors are proptosis or diplopia followed by ptosis, enophthalmos, pain, and decreased visual acuity [ 2 , 3 ]. RCC is a rare systemic malignancy comprising 2-4% of all tumors [ 2 , 3 ]. RCC most commonly metastasizes to the lung, bones, liver, and brain [ 2 ].…”

“…Masses in the anterior orbit can be often overlooked as many benign conditions present as a mass in the eyelid, including but not limited to a chalazion, hidrocystoma, amyloidosis, dermal fibrosis, papilloma, and epidermoid cyst [ 5 ]. In addition, clear cell RCC, the most common subtype of RCC, presents similarly to amelanotic choroidal melanoma due to its appearance as a lightly pigmented choroidal mass [ 3 , 4 , 6 ]. Therefore, diagnosis of RCC should be suspected in patients presenting with a mass in the eyelid with a previous history of RCC, even if the patient presumes to be in remission.…”

“…Although RCC has the potential to metastasize to other parts of the body, ophthalmic metastases are very rare. The orbit is the most likely the site of RCC metastasis to the eye followed by the choroid, iris, and lacrimal gland [2][3][4].…”