Transnasal Endoscopic Resection of the Intraconal Metastases From Renal Cell Carcinoma: a Case Report and Review of Literature

A case of uncommon metastasis located posterior to the seminal vesicles in renal cell carcinoma

Renal cell carcinoma (RCC) is known for its potential to metastasize to various sites but metastasis to the area posterior to the seminal vesicles is exceedingly rare. We present the case of a 44 year-old male patient with a history of clear cell RCC (ccRCC) who was found to have suspected metastases to the region posterior to the seminal vesicles and the greater omentum during follow-up after radical nephrectomy. The patient was classified as having a favorable risk according to the International Metastatic RCC Database Consortium criteria. Due to the rarity of this metastasis site, a treatment strategy combining immune-oncology therapy and tyrosine kinase inhibitors (IO-TKI) was initiated. This treatment led to significant reduction of the metastatic lesions, allowing for their complete removal via laparoscopic surgery. Pathologic examination confirmed that the metastatic lesions were consistent with primary ccRCC. No clinical progression was observed 2 months postoperatively. This case highlights the rare occurrence of ccRCC metastasizing posterior to the seminal vesicles and demonstrates the potential effectiveness of combined IO-TKI therapy followed by surgical resection in treating such atypical metastases.

Ocular adnexal metastases from renal cell carcinoma: An update and comprehensive literature review

PURPOSE:

The purpose of this study was to review the clinical presentation, systemic work-up, and outcomes of all previously reported ocular adnexal (OA) metastases from renal cell carcinoma (RCC).

METHODS:

This was a literature review. PubMed and Google Scholar databases were searched for all well-documented cases of OA metastases from RCC.

RESULTS:

Final analysis identified 44 patients with either biopsy-confirmed (41/44, 93%) or treatment response-documented (3/44, 6%) OA metastases from RCC. Thirty-four (77%) patients were male. The median age was 60 years (mean: 60, range: 22–87 years). The most common presenting signs were proptosis (19/44, 43%) and OA mass (14/44, 32%). Metastases most frequently involved the orbital bones (10/44, 23%) and adjacent extraconal fat, extending from the sinonasal tract in 7/10 (70%) of these cases. OA metastases were initial manifestation of RCC in 18/44 (41%) patients. At the time of primary tumor diagnosis, 22 of 30 (73%) patients had American Joint Committee on Cancer Stage IV disease with metastases to 2 or more sites in 13 (57%) patients. Seventeen of 42 (40%) patients underwent local therapy only, which most commonly included excision/exenteration with margin control (10/17, 59%). Twenty-five of 42 (60%) patients had systemic therapy, which included biologic agents and chemotherapy. The absolute 5-year survival rate was 66% with significantly improved survival in patients reported after 2006 (92% vs. 42%, P = 0.04) and in those with isolated OA metastases (100% vs. 27%, P = 0.02) at 30 months.

CONCLUSION:

Although RCC metastases to OA occur in a setting of advanced disease, the recent advances in diagnostic modalities and targeted therapies resulted in improved survival.