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Yin H, Du Z, Zhang J, Ma Y, Zhao S, Yang T. Case report: Isolated eyelid metastasis of ccRCC 5 years after receiving radical nephrectomy. Front Oncol 2024; 14:1321919. [PMID: 38559565 PMCID: PMC10978782 DOI: 10.3389/fonc.2024.1321919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Accepted: 03/01/2024] [Indexed: 04/04/2024] Open
Abstract
Introduction The most common sites of clear cell renal cell carcinoma(ccRCC) metastasis are the lung, bones, liver and brain; eyelid metastasis is a rare occurrence. Case presentation We report a case of ccRCC metastasis to the left eyelid after radical nephrectomy, and remission after sunitinib treatment. Conclusions Although the probability of eyelid metastasis rate is very low, tumor metastasis to the eyelid skin is possible after radical nephrectomy. Therefore, any rash like changes on the skin during the review procedure cannot be ignored by the physician.
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Affiliation(s)
- Huaqi Yin
- Department of Urology, The Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, China
| | - Zheng Du
- Department of Urology, The Affiliated People’s Hospital of Zhengzhou University, Henan provincial Hospital, Zhengzhou, China
| | - Jiuwen Zhang
- Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yongkang Ma
- Department of Urology, The Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, China
| | - Shiming Zhao
- Department of Urology, The Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, China
| | - Tiejun Yang
- Department of Urology, The Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, China
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Zrinšćak O, Kasumović A, Krolo I, Ivekovic R, Malenica Ravlić M, Tomašković I, Vatavuk Z. Solitary Clear Cell Renal Cell Carcinoma Metastasis to the Eyelid: A Case Report. Case Rep Oncol 2024; 17:477-483. [PMID: 38505734 PMCID: PMC10950357 DOI: 10.1159/000537860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 02/13/2024] [Indexed: 03/21/2024] Open
Abstract
Introduction This study is a case of solitary clear cell renal cell carcinoma (ccRCC) eyelid metastasis in a 66-year-old man as the first sign of a primary tumor. ccRCC usually spreads to the lungs, mediastinum, bones, liver, and brain, while ocular metastases are rare. Case Presentation Solitary metastasis presented as a solid mass in the central third of the upper eyelid, which has been growing for 3 weeks. Treatment included tumor removal and blepharoplasty. Histopathological examination showed metastasis of clear cell renal carcinoma. A thorough examination revealed a primary tumor on the lower pole of the right kidney. A right nephrectomy was performed, and histopathology showed ccRCC. Postoperative examinations showed no signs of local or systemic disease. Sunitinib malate was administered to the patient. Conclusion The eyelid metastasis in this case was still solitary and had been discovered before the existence of the primary tumor was known. Ocular metastasis of renal carcinoma is a rare initial manifestation of the disease and therefore requires a multidisciplinary approach in the treatment of these patients.
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Affiliation(s)
- Ognjen Zrinšćak
- University Department of Ophthalmology and Optometry, University Hospital Center, Sestre milosrdnice, Zagreb, Croatia
| | - Armin Kasumović
- University Department of Ophthalmology and Optometry, University Hospital Center, Sestre milosrdnice, Zagreb, Croatia
| | - Iva Krolo
- University Department of Ophthalmology, University Hospital Brussels, Brussels (UZ Brussel), Jette, Belgium
| | - Renata Ivekovic
- University Department of Ophthalmology and Optometry, University Hospital Center, Sestre milosrdnice, Zagreb, Croatia
| | - Maja Malenica Ravlić
- University Department of Ophthalmology and Optometry, University Hospital Center, Sestre milosrdnice, Zagreb, Croatia
| | - Igor Tomašković
- University Department of Urology, University Hospital Center, Sestre milosrdnice, Zagreb, Croatia
| | - Zoran Vatavuk
- University Department of Ophthalmology and Optometry, University Hospital Center, Sestre milosrdnice, Zagreb, Croatia
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Bellouki O, Ibrahimi A, Soufiani I, Boualaoui I, El Sayegh H, Nouini Y. Blepharoptosis revealing a metastatic renal cell carcinoma: A rare case report. Int J Surg Case Rep 2023; 112:108910. [PMID: 37837662 PMCID: PMC10667753 DOI: 10.1016/j.ijscr.2023.108910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Revised: 09/28/2023] [Accepted: 09/30/2023] [Indexed: 10/16/2023] Open
Abstract
INTRODUCTION Renal cell carcinoma (RCC) is a relatively rare malignancy often discovered incidentally. Approximately 15 % of cases are metastatic at diagnosis, commonly affecting the lungs, bones, lymph nodes, and liver. We present an exceptional case of RCC metastasizing to the eyelid. CASE PRESENTATION A 67-year-old female with no prior cancer history exhibited rapidly progressing left blepharoptosis. Examination revealed a painless, solid eyelid mass. Immunohistochemistry of the eyelid mass biopsy identified a carcinoma potentially of renal origin. A thorax, abdomen, and pelvis CT scan confirmed the presence of a right renal mass. Following a multidisciplinary discussion, we decided to proceed with an upfront cytoreductive nephrectomy and surgical excision of the eyelid metastasis. DISCUSSION Eyelid metastasis revealing a renal cell carcinoma is exceedingly rare. Immunohistochemistry plays a pivotal role in detecting primary renal tumors. Prognostic models, particularly the IMDC, guide therapeutic decisions. In the era of immune checkpoint inhibitors, cytoreductive nephrectomy remains a safe option for well-selected patients with favorable risk mRCC. CONCLUSION Recognizing unusual metastatic sites of RCC is vital due to its asymptomatic nature and the potential impact of delayed diagnosis on prognosis. Immunohistochemistry plays a critical role in diagnosis. Multidisciplinary tumor board discussions are essential for tailored management of favorable risk mRCC patients.
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Affiliation(s)
- Omar Bellouki
- Urology "A" Department, Ibn Sina University Hospital of Rabat, Morocco; Faculty of Medicine and Pharmacy of Rabat, Mohammed V University, Rabat, Morocco.
| | - Ahmed Ibrahimi
- Urology "A" Department, Ibn Sina University Hospital of Rabat, Morocco; Faculty of Medicine and Pharmacy of Rabat, Mohammed V University, Rabat, Morocco.
| | - Ilyas Soufiani
- Urology "A" Department, Ibn Sina University Hospital of Rabat, Morocco; Faculty of Medicine and Pharmacy of Rabat, Mohammed V University, Rabat, Morocco.
| | - Imad Boualaoui
- Urology "A" Department, Ibn Sina University Hospital of Rabat, Morocco; Faculty of Medicine and Pharmacy of Rabat, Mohammed V University, Rabat, Morocco.
| | - Hachem El Sayegh
- Urology "A" Department, Ibn Sina University Hospital of Rabat, Morocco; Faculty of Medicine and Pharmacy of Rabat, Mohammed V University, Rabat, Morocco.
| | - Yassine Nouini
- Urology "A" Department, Ibn Sina University Hospital of Rabat, Morocco; Faculty of Medicine and Pharmacy of Rabat, Mohammed V University, Rabat, Morocco.
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Jindal A, Kapatia G, Gupta G. Ocular metastasis from renal malignancies - A comprehensive review. Indian J Ophthalmol 2023; 71:3281-3289. [PMID: 37787223 PMCID: PMC10683680 DOI: 10.4103/ijo.ijo_3073_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 06/11/2023] [Accepted: 06/14/2023] [Indexed: 10/04/2023] Open
Abstract
The most common cause of intraocular mass is metastasis from other tumors. Renal malignancies, though rare, have a substantial number of cases with ocular metastasis, few of which were misdiagnosed. Many a times renal malignancies present with ocular manifestations before the primary diagnosis. Here in this article, we comprehensively reviewed 106 cases of ocular metastasis from renal malignancies published till date to the best of our knowledge. The eye is a rare site for distant metastasis because of the lack of a lymphatic system. The most common ocular structures to get involved in distant metastasis are the uveal tract, i.e., choroid, iris, and ciliary body. The most common renal tumor which metastasizes to eyes is renal cell carcinoma (RCC). RCC accounts for less than 2% of all ophthalmic metastases. Out of total 106 cases, the type of renal malignancy was known in 95 cases only, of which 92 had RCC, 1 Wilm's tumor, 1 rhabdoid tumor, and 1 medullary carcinoma. The age ranged widely from 2 weeks old to 81 years old. The male to female ratio was 3.4:1. In total, 67.4% of cases had a previous history of RCC, while the rest 32.6% primarily presented with ophthalmic manifestations first. Treatment modalities included enucleation of the eye, debulking surgery followed by radiotherapy and/or chemotherapy and/or immunotherapy.
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Affiliation(s)
- Akriti Jindal
- Department of Pathology, All India Institute of Medical Sciences, Bathinda, Punjab, India
| | - Gargi Kapatia
- Department of Pathology, All India Institute of Medical Sciences, Bathinda, Punjab, India
| | - Gaurav Gupta
- Department of Ophthalmology, Eye Sure Super-Speciality Eye Hospital, Bathinda, Punjab, India
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Nabih O, Mtalai N, EL Maaloum L, Allali B, EL kettani A. Orbital metastases from prostate adenocarcinoma: Case report and review of the literature. Ann Med Surg (Lond) 2022; 76:103530. [PMID: 35495399 PMCID: PMC9052295 DOI: 10.1016/j.amsu.2022.103530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 03/09/2022] [Accepted: 03/26/2022] [Indexed: 11/25/2022] Open
Abstract
Introduction Prostate carcinoma metastasizes usually to lymph nodes and bone. Its metastases to the orbital cavity remain very rare. Observation We report here the case of an 80-year-old man diagnosed with a non-metastatic prostate adenocarcinoma 9 months earlier, who was found to have an orbital metastasis revealed by a proptosis of his left eye. He received hormonal therapy, chemotherapy and radiotherapy. Discussion Orbital metastases from prostate carcinoma have many similarities to other orbital metastases in their presentation. Their diagnosis is easily done when there is a history of a primary tumor. Presenting symptoms include proptosis, limitation of eye movements, diplopia and decreased vision. Conclusion Through this case report and a review of literature, we discuss the incidence, the clinical presentation and the management of these tumors.
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Blasi MA, Maceroni M, Caputo CG, Sammarco MG, Scupola A, Lenkowicz J, Schinzari G, Rossi E, Pagliara MM. Clinical and ultrasonographic features of choroidal metastases based on primary cancer site: Long-term experience in a single center. PLoS One 2021; 16:e0249210. [PMID: 33765045 PMCID: PMC7993812 DOI: 10.1371/journal.pone.0249210] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 03/14/2021] [Indexed: 01/29/2023] Open
Abstract
Introduction and purpose Choroidal metastases (CM) are the most common intraocular malignancies. With longer survival rates for cancer patients, CM will be increasingly encountered. We evaluated clinical and ultrasonographic (US) characteristics of CM in order to identify diagnostic biomarkers that correlate with the primary tumor site. Methods The medical records of all patients with CM evaluated at the Ocular Oncology Unit between February 2010 and March 2020 were analyzed. Results 82 eyes of 70 patients were included. The primary cancer site was lung in 26 patients (37%), breast in 23 (33%), kidney in 9 (13%), gastrointestinal in 5 (7%), thyroid in 5 (7%), parathyroids and prostate respectively in 2 (3%). Fifty-five patients (78%) had other systemic metastases at the time of ocular diagnosis. Ten (14%) patients had no history of primary cancer. Bilateral CM were found in 20 patients (29%); fifty-six eyes (68%) had a single CM. The epicenter of CM was predominantly macula (43 eyes, 52%). The mean thickness was 4,1 mm (range 1,8–12,3). US structure was inhomogeneous in 67 eyes (82%). Reflectivity was mainly medium (39%) and medium-low (39%). In particular, CM from lung cancer showed lower reflectivity than those from the breast (p = 0,02). CM deriving from lung cancer were typically dome-shaped, whereas CM originating from breast were characteristically plateau shaped (p = 0,02). Seventy-four (91%) eyes presented fluid on optical coherence tomography. Conclusion We significatively found that CM from lung cancer generally appear dome-shaped with medium-low internal reflectivity, whereas those from breast cancer typically present a plateau appearance and higher internal reflectivity. Though it is hard to identify the site of the primary tumor relying exclusively on clinical and US aspects, morphology and internal reflectivity can be considered as diagnostic biomarkers. Thus, the origin of the primary tumor can be suspected by integrating a constellation of findings.
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Affiliation(s)
- Maria Antonietta Blasi
- Università Cattolica del Sacro Cuore, Rome, Italy
- UOC Oncologia Oculare, Fondazione Policlinico Universitario A. Gemelli - IRCCS, Rome, Italy
| | - Martina Maceroni
- Università Cattolica del Sacro Cuore, Rome, Italy
- UOC Oncologia Oculare, Fondazione Policlinico Universitario A. Gemelli - IRCCS, Rome, Italy
- * E-mail:
| | - Carmela Grazia Caputo
- UOC Oncologia Oculare, Fondazione Policlinico Universitario A. Gemelli - IRCCS, Rome, Italy
| | - Maria Grazia Sammarco
- UOC Oncologia Oculare, Fondazione Policlinico Universitario A. Gemelli - IRCCS, Rome, Italy
| | - Andrea Scupola
- UOC Oncologia Oculare, Fondazione Policlinico Universitario A. Gemelli - IRCCS, Rome, Italy
| | - Jacopo Lenkowicz
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Giovanni Schinzari
- Università Cattolica del Sacro Cuore, Rome, Italy
- Oncologia Medica, Fondazione Policlinico Universitario, A. Gemelli IRCCS, Rome, Italy
| | - Ernesto Rossi
- Oncologia Medica, Fondazione Policlinico Universitario, A. Gemelli IRCCS, Rome, Italy
| | - Monica Maria Pagliara
- UOC Oncologia Oculare, Fondazione Policlinico Universitario A. Gemelli - IRCCS, Rome, Italy
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Milman T, Magan T, Pradeep T, Tuluc M, Bilyk J. Ocular adnexal metastases from renal cell carcinoma: An update and comprehensive literature review. Saudi J Ophthalmol 2021; 35:209-216. [PMID: 35601855 PMCID: PMC9116086 DOI: 10.4103/sjopt.sjopt_96_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 05/20/2021] [Indexed: 11/23/2022] Open
Abstract
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.
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Heichel J, Siebolts U, Wickenhauser C, Viestenz A. [Periocular metastasis as differential diagnosis of pyogenic granuloma and therapeutic marker of a systemic disease]. Ophthalmologe 2019; 116:1074-1078. [PMID: 30874885 DOI: 10.1007/s00347-019-0877-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND A pyogenic granuloma is a frequent palpebral pseudotumor. Showing a typical clinical picture after an inflammation (hordeolum, chalazion) it can be easily diagnosed and sometimes a histopathological analysis is thought to be unnecessary. METHODS A case report of a patient suffering from a palpebral metastasis of a clear cell renal cell carcinoma (cRCC) as an atypical differential diagnosis of an inflammatory pseudotumor of the eyelid is presented. RESULTS A 72-year-old man presented for surgical treatment of a pyogenic granuloma. The medial portion of the inferior eyelid showed a nodular and pediculate lesion of the tarsal conjunctiva. At the time of presentation the patient was receiving adjuvant systemic treatment with cabozantinib because of lymphonodal and pulmonal metastases of the cRCC. The tumor was resected and the histopathological examination revealed a sarcomatoid dedifferentiated metastasis of the cRCC. After 4 weeks the tumor showed a local recurrence and histologically a local relapse was found. Therefore, a change in the systemic therapy was initiated (nivolumab). In the follow-up of 18 months no recurrence of the palpebral tumor occurred. A stable disease condition of the cRCC was achieved. CONCLUSION Even if the clinical aspect of an inflammatory tumor of the lids seems to be clear, a histopathological examination is still necessary. An interdisciplinary approach with reevaluation of the systemic therapy led to an improvement of the patient treatment.
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Affiliation(s)
- Jens Heichel
- Universitätsklinik und Poliklinik für Augenheilkunde, Universitätsklinikum Halle (Saale), Ernst-Grube-Str. 40, 06120, Halle, Deutschland.
| | - Udo Siebolts
- Institut für Pathologie, Martin-Luther-Universität Halle-Wittenberg, Halle, Deutschland
| | - Claudia Wickenhauser
- Institut für Pathologie, Martin-Luther-Universität Halle-Wittenberg, Halle, Deutschland
| | - Arne Viestenz
- Universitätsklinik und Poliklinik für Augenheilkunde, Universitätsklinikum Halle (Saale), Ernst-Grube-Str. 40, 06120, Halle, Deutschland
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Mathis T, Jardel P, Loria O, Delaunay B, Nguyen AM, Lanza F, Mosci C, Caujolle JP, Kodjikian L, Thariat J. New concepts in the diagnosis and management of choroidal metastases. Prog Retin Eye Res 2018; 68:144-176. [PMID: 30240895 DOI: 10.1016/j.preteyeres.2018.09.003] [Citation(s) in RCA: 69] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2018] [Revised: 09/04/2018] [Accepted: 09/07/2018] [Indexed: 12/17/2022]
Abstract
The most frequent site of ocular metastasis is the choroid. The occurrence of choroidal metastases has increased steadily due to the longer survival of metastatic patients and the improvement of diagnostic tools. Fundoscopy, ultrasonography, and fluorescein angiography are now complemented by indocyanine green angiography and optical coherence tomography. Choroidal tumor biopsy may also confirm the metastatic nature of the tumor and help to determine the site of the primary malignancy. There is currently no consensus on the treatment strategy. Most patients have a limited life expectancy and for these complex treatments are generally not recommended. However, recent advances in systemic therapy have significantly improved survival of certain patients who may benefit from an aggressive ocular approach that could preserve vision. Although external beam radiation therapy is the most widely used treatment, more advanced forms of radiotherapy that are associated with fewer side effects can be proposed in select cases. In patients with a shorter life expectancy, systemic therapies such as those targeting oncogenic drivers, or immunotherapy can induce a regression of the choroidal metastases, and may be sufficient to temporarily decrease visual symptoms. However, they often acquire resistance to systemic treatment and ocular relapse usually requires radiotherapy for durable control. Less invasive office-based treatments, such as photodynamic therapy and intravitreal injection of anti-VEGF, may also help to preserve vision while reducing time spent in medical settings for patients in palliative care. The aim of this review is to summarize the current knowledge on choroidal metastases, with emphasis on the most recent findings in epidemiology, pathogenesis, diagnosis and treatment.
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Affiliation(s)
- Thibaud Mathis
- Department of Ophthalmology, Croix-Rousse University Hospital, Hospices Civils de Lyon, 69317, Lyon, France; UMR-CNRS 5510 Matéis, 69100, Villeurbane, France
| | - Pauline Jardel
- Department of Radiation Oncology, Chicoutimi Hospital, Saguenay, QC, Canada
| | - Olivier Loria
- Department of Ophthalmology, Croix-Rousse University Hospital, Hospices Civils de Lyon, 69317, Lyon, France
| | - Benoit Delaunay
- Department of Ophthalmology, Croix-Rousse University Hospital, Hospices Civils de Lyon, 69317, Lyon, France
| | - Anh-Minh Nguyen
- Department of Ophthalmology, Croix-Rousse University Hospital, Hospices Civils de Lyon, 69317, Lyon, France
| | - Francesco Lanza
- Department of Ophthalmology, Ocular Oncology Center, E.O. Ospedali Galliera, Genoa, Italy
| | - Carlo Mosci
- Department of Ophthalmology, Ocular Oncology Center, E.O. Ospedali Galliera, Genoa, Italy
| | | | - Laurent Kodjikian
- Department of Ophthalmology, Croix-Rousse University Hospital, Hospices Civils de Lyon, 69317, Lyon, France; UMR-CNRS 5510 Matéis, 69100, Villeurbane, France
| | - Juliette Thariat
- Department of Radiation Therapy, Centre François Baclesse - ARCHADE, Unicaen - Normandie University, 14000, Caen, France.
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Mezer E, Gdal-On M, Miller B. Orbital Metastasis of Renal Cell Carcinoma Masquerading as Amaurosis Fugax. Eur J Ophthalmol 2018; 7:301-4. [PMID: 9352288 DOI: 10.1177/112067219700700318] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Renal cell carcinoma (RCC) is the most common malignancy involving the kidney. Only rarely does it metastasize to the eye and orbit, sometimes mimicking other lesions. A 70-year-old woman was referred from neurology because of a right orbital lesion, six months after the start of a neurological investigation because of amaurosis fugax. Six months earlier she had complained of transient visual disturbances in her right eye. After excluding cardiovascular abnormalities and coagulopathies as the source of her complaints, she was diagnosed as having a right senile ptosis. A computed tomography scan, done to complete the workout, detected a right orbital mass. The patient was referred to the oculoplastic unit. A biopsy and then a lateral orbitotomy were performed. Histopathological examination proved it to be a metastatic renal cell carcinoma, seven years after the primary tumor had been diagnosed and treated by nephrectomy. The characteristics of metastatic renal cell carcinoma are discussed, in view of the rarity of metastasis to the eye and, in particular, to the orbit, and its tendency to masquerade as other lesions or symptoms. In this case it presented as amaurosis fugax before other signs appeared.
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Affiliation(s)
- E Mezer
- Department of Ophthalmology, Rambam Medical Center, Haifa, Israel
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Küchle M, Holbach L, Schlötzer-Schrehardt U. Gastric Adenocarcinoma Presenting as an Eyelid and Conjunctival Mass. Eur J Ophthalmol 2018; 2:3-9. [PMID: 1322210 DOI: 10.1177/112067219200200102] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
A 50-year-old white man complained of “inflammation” of his right eyelid since January 1989. In June 1990, he had undergone a gastrectomy for an adenocarcinoma of the stomach. In August 1990, his right eye showed a painless, firm infiltration of the upper and lower lid, ulceration and loss of eyelashes of the upper lid and a reddish, subepithelial thickening of the medial bulbar conjunctiva. Biopsies of the right upper lid and nasal bulbar conjunctiva disclosed a metastatic, poorly differentiated adenocarcinoma of the stomach (signet ring cell carcinoma) both in the lid and conjunctival biopsies. Carcinoembryonic antigen (CEA) was detected in the tumor cells. Electron microscopic examination revealed tumor cells with signs of secretory activity. Although metastases to the eyelids and conjunctiva are rare, they may precede the clinical manifestation of the primary tumor for months or even years. In patients with chronic, recalcitrant lesions of eyelids or conjunctiva, especially if accompanied by loss of eyelashes, a primary or secondary malignancy should be excluded by early biopsies and histopathological examination.
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Affiliation(s)
- M Küchle
- Department of Ophthalmology, University of Erlangen-Nürmberg, Germany
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12
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Komanski CB, Rubino SM, Meyer JC, Greven CM. Choroidal Melanoma Mimicker: A Case of Metastatic Clear-Cell Renal Cell Carcinoma. Ocul Oncol Pathol 2018; 3:279-282. [PMID: 29344481 DOI: 10.1159/000462975] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Revised: 02/03/2017] [Indexed: 11/19/2022] Open
Abstract
Choroidal melanoma is the most common primary intraocular malignancy, yet metastatic disease remains the most common malignancy of the eye. Differentiating these entities is essential as treatment, systemic associations, and prognosis vary dramatically between the two. Established diagnostic criteria are accurate for the diagnosis of uveal melanoma. Yet, metastatic disease may be misdiagnosed as a uveal melanoma in rare cases. We report a case of metastatic clear-cell renal cell carcinoma masquerading as uveal melanoma. A 73-year-old Caucasian man with a history of renal cell carcinoma presented with a 15 × 12 × 7 mm homogenous, pigmented, and acoustically hollow mass without hemorrhage or exudation. The patient was initially treated with plaque radiotherapy with good tumor regression. However, the patient developed pain and vision loss due to total exudative retinal detachment. Subsequent enucleation allowed histopathologic confirmation of clear-cell renal cell carcinoma. Nine years following enucleation, the patient remains in complete remission without evidence of other systemic metastases. Renal cell carcinoma should be considered when evaluating patients with probable uveal melanoma. Delayed-onset ocular metastasis from renal cell carcinoma exhibits an atypical clinical course with the possibility of durable remission following enucleation.
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Affiliation(s)
- Chris B Komanski
- Department of Ophthalmology, Wake Forest Baptist Health, Winston-Salem, North Carolina, USA
| | - Shaina M Rubino
- Department of Ophthalmology, Wake Forest Baptist Health, Winston-Salem, North Carolina, USA
| | - Jacob C Meyer
- Department of Ophthalmology, Wake Forest Baptist Health, Winston-Salem, North Carolina, USA
| | - Craig M Greven
- Department of Ophthalmology, Wake Forest Baptist Health, Winston-Salem, North Carolina, USA
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Alasil T, Khazai B, Loredo L, Rauser ME. Renal cell carcinoma metastasis to the ciliary body responds to proton beam radiotherapy: a case report. J Med Case Rep 2011; 5:345. [PMID: 21812958 PMCID: PMC3163216 DOI: 10.1186/1752-1947-5-345] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2011] [Accepted: 08/03/2011] [Indexed: 11/11/2022] Open
Abstract
Introduction We report an unexpected presentation of metastatic renal cell carcinoma (RCC) to the ciliary body and an interesting response to proton beam radiotherapy. Case presentation We encountered a case of angle-closure glaucoma as the initial presentation of ocular metastasis to the ciliary body in a 65-year-old Caucasian man who had undergone right radical nephrectomy for RCC 15 years earlier. He underwent YAG (yttrium aluminium garnet) laser peripheral iridotomy while further metastatic workup took place. His condition was eventually diagnosed as stage IV metastatic RCC of the clear cell type and involved multiple sites, including the ciliary body, brain, lungs, liver, and pancreas. The progression of RCC metastasis to the ciliary body was studied for 16 months. The ciliary body mass continued to grow despite systemic treatment with temsirolimus and interleukin-2 and intravitreal injections of bevacizumab. The tumor size peaked at 6.11 × 6.06 mm before the start of proton therapy, which reduced the tumor size to 5.07 × 4.39 mm. Conclusions RCC can produce metastases involving unusual sites many years after resection of the primary tumor. Proton therapy was found to be effective in treating RCC metastasis to the ciliary body in settings in which other treatment modalities failed.
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Affiliation(s)
- Tarek Alasil
- Department of Ophthalmology, Loma Linda University, Loma Linda, CA 92354, USA.
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Berman AT, Rengan R, Tripuraneni P. Radiotherapy for eyelid, periocular, and periorbital skin cancers. Int Ophthalmol Clin 2009; 49:129-142. [PMID: 20203540 DOI: 10.1097/iio.0b013e3181b80580] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Affiliation(s)
- Abigail T Berman
- Department of Radiation/Oncology, University of Pennsylvania School of Medicine, Philadelphia, PA 19104, USA
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Preechawai P, Amrith S, Yip CC, Goh KY. Orbital metastasis of renal cell carcinoma masquerading as cysticercosis. Orbit 2008; 27:370-3. [PMID: 18836935 DOI: 10.1080/01676830802316688] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Metastasis to the orbital soft tissues is relatively uncommon. We report a rare case of renal cell carcinoma with orbital metastasis as the first clinical manifestation. A 48-year-old-man presented with left proptosis and complete ptosis of three weeks duration. Radiological examination revealed a left intraconal heterogeneous cyst-like lesion with rim enhancement immediately deep to the left superior rectus muscle. Diagnosed as having orbital cysticercosis, he was prescribed oral albendazole and prednisolone. But there was no clinical improvement. An incisional biopsy performed showed metastatic poorly differentiated carcinoma. The patient complained of backache and weight loss in the interim. Magnetic resonance imaging (MRI) of the spine showed extensive vertebral metastasis to the thoracic and lumbosacral spine and the iliac bone, with an incidental detection of a large mass from the right kidney. Further MRI of abdomen and chest showed a large right renal mass presumed to be a renal cell carcinoma with extension into the right renal vein, intra-abdominal lymph nodes, and peritoneum. There were small nodules in the lung suggesting the possibility of pulmonary metastatic deposits. Renal cell carcinoma does not respond to chemotherapy, immunotherapy, or radiation; because of the disease's advanced stage, the patient received palliative treatment. There have been only two other reports in the literature of metastatic renal cell carcinoma in the orbit where the proptosis was the initial presenting feature similar to our case.
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Affiliation(s)
- Passorn Preechawai
- Department of Ophthalmology, Faculty of Medicine, Prince of Songkla University, Had Yai, Songkhla, Thailand
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Mudiyanselage SY, Prabhakaran VC, Davis GJ, Selva D. Metastatic renal cell carcinoma presenting as a circumscribed orbital mass. Eur J Ophthalmol 2008; 18:483-5. [PMID: 18465741 DOI: 10.1177/112067210801800332] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To report a case of renal cell carcinoma presenting as a well-circumscribed orbital tumor. METHODS Retrospective interventional case report. RESULTS A 60-year-old woman presented with proptosis of the left eye. Imaging showed a well circumscribed tumor in the region of the medial rectus muscle. Excision biopsy revealed a diagnosis of metastatic renal cell carcinoma that was confirmed on abdominal imaging. CONCLUSIONS Renal cell carcinoma can rarely present as a well-circumscribed orbital mass and should be included in the differential diagnosis of such lesions.
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Affiliation(s)
- S Y Mudiyanselage
- South Australian Institute of Ophthalmology and Department of Ophthalmology and Visual Sciences, University of Adelaide, Adelaide - South Australia
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17
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Shome D, Honavar SG, Gupta P, Vemuganti GK, Reddy PVA. Metastasis to the Eye and Orbit from Renal Cell Carcinoma—A Report of Three Cases and Review of Literature. Surv Ophthalmol 2007; 52:213-23. [PMID: 17355859 DOI: 10.1016/j.survophthal.2006.12.004] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
We report three cases of renal cell carcinoma metastatic to the eye and orbit and review the relevant literature. The case reports of a 67-year-old man, a 58-year-old man, and a 23-year-old woman with metastatic renal cell carcinoma are described. The iris mass occurred in a 67-year-old man, a known case of renal cell carcinoma. Whereas the orbital metastasis in the 58-year-old man was the initial presenting sign in a hitherto undiagnosed patient, the orbital metastasis in the 23-year-old female patient was detected following nephrectomy for renal cell carcinoma. Renal cell carcinoma metastasizing to the eye and orbit are very rare, with only 68 cases reported previously. In patients presenting with atypical orbital or ocular masses, the possibility of renal cell carcinoma metastasis should be considered, especially if there is a history of previous renal disorder. Incisional biopsy with histopathological evaluation may be an important means to diagnose this condition and facilitate appropriate therapy.
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Affiliation(s)
- Debraj Shome
- Ocular Oncology Service, LV Prasad Eye Institute, Hyderabad, India
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Tailor R, Inkster C, Hanson I, Shackley DC, Smyth K. Metastatic renal cell carcinoma presenting as a chalazion. Eye (Lond) 2006; 21:564-5. [PMID: 17115017 DOI: 10.1038/sj.eye.6702645] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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Abstract
Renal carcinoma, the third most common urological cancer, induces presence of metastases in 75% of cases. The most affected sites for metastasis are the lungs, the lymphatic system, bones, the liver, adrenal glands and the brain with sometimes a cancer free period of several years prior to evolutionary recurrence of the disease. The aim of this literature review is to report on secondary uncommon renal localizations by underlining their clinical significance, as well as main characteristics, in order to provide guidelines for effective patient diagnosis and therapeutic management.
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Affiliation(s)
- A Vidart
- Service d'urologie, CHU Rouen, 1, rue de Germont, 76031 Rouen, France
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20
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Kurli M, Finger PT, Schneider S, Tena LB. Eyelid-sparing adjuvant radiation therapy for renal cell carcinoma. Ophthalmologica 2006; 220:198-200. [PMID: 16679797 DOI: 10.1159/000091766] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2005] [Accepted: 07/01/2005] [Indexed: 11/19/2022]
Abstract
PURPOSE To describe the use of debulking surgery with adjuvant external beam irradiation as an eyelid-sparing treatment for renal cell carcinoma. DESIGN Interventional case report. METHODS A 63-year-old male presented with a right upper lid tumor. He had a history of renal cell carcinoma and pulmonary metastasis treated with surgery and systemic chemotherapy. The eyelid tumor was biopsied, followed by debulking surgery and external beam radiation therapy to treat this metastatic tumor. RESULTS Histopathological evaluation of the excised tumor revealed a metastatic renal cell carcinoma, clear cell type. At 4 months' follow-up, he had no evidence of recurrence or radiation oculopathy. He was pleased with his cosmetic result. CONCLUSIONS Meta static renal cell carcinoma presenting in the eye and orbit can be the initial manifestation of the primary tumor. It is important to include this tumor in the differential diagnosis of recurrent eyelid lesions. Debulking surgery followed by external beam radiation therapy can be used to control the tumor with an eyelid-sparing cosmetic result.
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Affiliation(s)
- Madhavi Kurli
- The New York Eye Cancer Center, New York, NY 10021, USA
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21
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Hart RH, Luthert PJ, Rose GE. Renal cell carcinoma metastasis masquerading as recurrent orbital haematoma. Orbit 2005; 24:281-4. [PMID: 16354640 DOI: 10.1080/01676830500263794] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
A 70 year old man developed orbital haemorrhage after retrobulbar anaesthesia for cataract surgery and biopsy of a persistent lateral rectus mass suggested organising haematoma. Subsequent progression of the mass was shown, on repeated biopsy, to be due to metastatic renal cell carcinoma--a tumour recognised for its angiogenic and haemorrhagic potential.
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22
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Pompeu ACL, Arap S, Silva MNR, Monteiro DS. Ocular metastasis as first presentation of renal cell carcinoma: report of 2 cases. Clinics (Sao Paulo) 2005; 60:75-8. [PMID: 15838585 DOI: 10.1590/s1807-59322005000100014] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
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.
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Shields JA, Shields CL, Brotman HK, Carvalho C, Perez N, Eagle RC. Cancer metastatic to the orbit: the 2000 Robert M. Curts Lecture. Ophthalmic Plast Reconstr Surg 2001; 17:346-54. [PMID: 11642491 DOI: 10.1097/00002341-200109000-00009] [Citation(s) in RCA: 222] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To report the demographics and clinical features of a large series of patients with orbital metastasis. METHODS Retrospective chart review on 100 consecutive patients and a literature review on orbital metastasis. RESULTS Of 100 patients, the primary tumor site was breast in 53 (53%), prostate gland in 12 (12%), lung in 8 (8%), skin (melanoma) in 6 (6%), kidney in 5 (5%), gastrointestinal tract in 5 (5%), choroid (melanoma) in 2 (2%), parotid gland in 1 (1%), and adrenal gland (neuroblastoma) in 1 (1%). Of patients in whom a detailed history was available, there was no history of cancer at the time of presentation in 19%. In 10%, the primary tumor remained undetected despite systemic evaluation. There were 36 male patients and 64 female patients whose mean age at diagnosis was 62 years (median 60 years, range 5 to 91 years). Both the right and left orbits were affected equally, and 4 cases (4%) were bilateral. The most frequent clinical findings were limited ocular motility (54%), proptosis (50%), and palpable mass (43%). The diagnoses were established by history, systemic survey, imaging studies, and biopsy. Treatment included chemotherapy, hormone therapy, irradiation, surgical excision, or observation, depending on clinical circumstances. Among patients with sufficient follow-up, 95% died of metastasis, with overall mean survival of 15 months (median 15 months; range 3 to 96 months) after orbital diagnosis. CONCLUSIONS The most common primary cancers that metastasize to the orbit are breast, prostate gland, and lung cancer. In 19%, there is no history of cancer when the patient presents with ophthalmic symptoms and in 10% the primary site remains obscure despite systemic evaluation. The systemic prognosis is generally poor.
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Affiliation(s)
- J A Shields
- Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania 19107, USA
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Shields JA, Shields CL, Eagle RC, Singh AD, Armstrong T. Metastatic renal cell carcinoma to the palpebral lobe of the lacrimal gland. Ophthalmic Plast Reconstr Surg 2001; 17:191-4. [PMID: 11388385 DOI: 10.1097/00002341-200105000-00008] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To describe a clinicopathologic correlation of a metastatic renal cell carcinoma to lacrimal gland. METHODS Case report. RESULTS A 59-year-old man with a history of renal cell carcinoma had a hemorrhagic mass involving the palpebral lobe of the right lacrimal gland. Fundus examination disclosed two lesions with typical features of choroidal metastasis. The lacrimal gland mass was excised, and histopathologic examination revealed metastatic renal cell carcinoma. The patient was treated for systemic metastasis but required no further ocular treatment. CONCLUSIONS Renal cell carcinoma can metastasize to the lacrimal gland, where it may appear as a hemorrhagic mass.
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Affiliation(s)
- J A Shields
- Oncology Service, Thomas Jefferson University, Philadelphia, Pennsylvania 19107, USA
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Abstract
PURPOSE To report a case of metastatic renal cell carcinoma with involvement of the iris and bulbar conjunctiva. METHODS Case report. A 70-year-old man without known systemic disease developed an iris mass in his left eye. Iridocyclectomy was performed to remove the iris mass. RESULTS Histopathologically, the iris mass was consistent with metastatic renal cell carcinoma. Further evaluation disclosed a mass of the left kidney. The patient underwent a left nephrectomy and was found to have renal cell carcinoma, with focal penetration into the renal capsule. One month after the nephrectomy, he developed a highly vascular nodule of the left bulbar conjunctiva. An excisional biopsy was performed, and histopathology disclosed an additional focus of renal cell carcinoma. CONCLUSIONS Iris and conjunctival involvement may be a clinical manifestation of renal cell carcinoma. Renal cell carcinoma should be considered in the differential diagnosis of a fleshy, vascular iris and a conjunctival nodule.
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Affiliation(s)
- G T Ware
- Department of Ophthalmology, University of Tennessee, Memphis 38163, USA
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Haimovici R, Gragoudas ES, Gregor Z, Pesavento RD, Mieler WF, Duker JS. Choroidal metastases from renal cell carcinoma. Ophthalmology 1997; 104:1152-8. [PMID: 9224469 DOI: 10.1016/s0161-6420(97)30169-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Choroidal metastases from renal cell carcinoma are uncommon. The authors investigated the clinical characteristics of patients with renal cell carcinoma in whom choroidal metastases developed. METHODS The clinical records of five patients with histopathologically confirmed renal cell carcinoma and choroidal metastases were reviewed retrospectively. RESULTS In four patients, choroidal metastases were either the sole initial manifestation of disease or were the initial manifestation of metastatic disease. The interval from nephrectomy to the onset of ocular signs ranged from 6 to 18 years. A reddish-orange appearance of the tumor was present in two patients, but no pathognomonic features distinguishing these tumors from other choroidal metastases were identified. CONCLUSIONS Ocular metastases may precede the diagnosis of renal cell carcinoma or may follow it by years or decades. This interval between its ocular and systemic presentation may be so prolonged as to obscure the relation between the choroidal metastases and the primary tumor. In patients with amelanotic or reddish choroidal lesions without known metastatic disease, evaluation of the kidney may be warranted as part of a metastatic workup to exclude metastatic renal cell carcinoma.
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Affiliation(s)
- R Haimovici
- Department of Ophthalmology, Boston University School of Medicine, Massachusetts, USA
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Pagano S, Franzoso F, Ruggeri P. Renal cell carcinoma metastases. Review of unusual clinical metastases, metastatic modes and patterns and comparison between clinical and autopsy metastatic series. SCANDINAVIAN JOURNAL OF UROLOGY AND NEPHROLOGY 1996; 30:165-72. [PMID: 8837246 DOI: 10.3109/00365599609181294] [Citation(s) in RCA: 48] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
We reviewed all cases of unusual clinical metastases of renal cell carcinoma found in the English literature. The percentages of usual and unusual clinical metastases are compared with data of some large autopsy series. The involvement of various organs is considered and some metastatic modes and patterns are reported. The analysis shows that clinical metastases are obviously underdiagnosed. Correct staging based on careful clinical investigations is paramount for optimal management of metastatic renal cancer.
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Affiliation(s)
- S Pagano
- Department of Urology, Niguarda Ca'Granda Hospital, Milano, Italy
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De Potter P, Shields JA, Shields CL, Yannuzzi LA, Fisher YE, Rao VM. Unusual MRI findings in metastatic carcinoma to the choroid and optic nerve: a case report. Int Ophthalmol 1992; 16:39-44. [PMID: 1537648 DOI: 10.1007/bf00917071] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
A 51 year old man with biopsy proven pulmonary sarcoidosis and skin test positive for tuberculosis presented with features of an amelanotic flat choroidal mass suggestive of choroiditis. The mass enlarged despite corticosteroids and anti-tuberculous medications. A thorough systemic evaluation for possible primary tumor metastatic to the choroid was negative. Further clinical evaluation and magnetic resonance imaging suggested a diffuse primary choroidal malignant melanoma with optic nerve invasion. The eye was enucleated and the mass proved histopathologically to be a mucin secreting adenocarcinoma of unknown origin despite a repeat systemic work-up. The patient died three months after the onset of symptoms and three weeks after enucleation with diffuse metastases from an unknown primary cancer. Magnetic resonance imaging (MRI) is usually helpful in the differentiation of uveal melanoma from uveal metastasis. In this case, however, it suggested the diagnosis of a diffuse choroidal melanoma. The reason for the atypical MRI findings will be discussed.
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Affiliation(s)
- P De Potter
- Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania
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30
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Holbach LM, Chévez P, Snyder WB, Font RL. Unsuspected renal cell carcinoma metastatic to the choroid nine years after nephrectomy. Am J Ophthalmol 1990; 110:441-3. [PMID: 2220990 DOI: 10.1016/s0002-9394(14)77038-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- L M Holbach
- Department of Ophthalmology, Cullen Eye Institute, Baylor College of Medicine, Houston, TX 77030
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Abstract
Clinical characteristics of tumors metastatic to the orbit are related to primary tumor biology, and vary substantially among the various primary types. Common known primary sites include breast, lung, prostate, and melanoma. Tumor presentations can be classified into four generalized syndromes of mass, infiltrative, inflammatory, and functional effects. We found the infiltrative syndrome of presentation to be more common than for other types of orbital neoplasm. Accurate diagnosis often depends on recognition of the types of clinical syndromes and on the use of diagnostic modalities such as computed tomography, magnetic resonance imaging, fine needle aspiration biopsy, and open biopsy. Special histologic techniques are often useful in determining the origin of these often poorly differentiated tumors, and can provide a basis for specific hormonal therapy. Ophthalmologists play a vital role in the diagnosis of metastatic cancer; the orbital tumor was the presenting sign of systemic cancer in 42% of the cases reviewed. Although the overall prognosis for patients with metastatic cancer is quite poor, specific therapy is available for a growing number of cancers. Timely intervention based on accurate diagnosis can dramatically improve the duration and quality of life with selected tumors.
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Affiliation(s)
- R A Goldberg
- Department of Ophthalmology, Vancouver General Hospital, University of British Columbia, Canada
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Abstract
The authors report a patient treated with radiation therapy for a lumbosacral chordoma. The first and only evidence of metastatic disease was an eyelid cyst. This case is unusual for several reasons. First, eyelid metastases are rare; they are much more uncommon than metastases to the uvea or orbit. Second, metastatic tumors to the eyelid are usually manifestations of widespread disease and seldom occur as a solitary focus of dissemination. Third, the clinical presentation of our patient's lesion as an eyelid cyst is uncommon for a metastasis to the eyelid. Finally, to the best of our knowledge, all previously reported tumors metastatic to the eyelid have been carcinomas; this is the first report of a metastatic soft-tissue tumor to the eyelid.
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Affiliation(s)
- T J Malone
- Oculoplastic, Orbital and Oncology Service, University of Iowa Hospitals and Clinics, Iowa City 52242
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Abstract
The authors conducted a clinicopathologic study of 31 patients with metastatic disease to the eyelid at the Armed Forces Institute of Pathology. Metastasis was found predominantly in women (female/male = 4:1). The mean age was 69 years (range, 3-92). The most common primary sites were breast (35%), skin (16%), and gastrointestinal and urogenital tracts (each 10%). Aside from breast carcinoma, there was no sex predilection for the extramammary malignancies to metastasize to the eyelids. Metastasis was suspected in only 32% of the cases. Most common misdiagnoses were chalazion, cyst, granuloma, and xanthoma. The lid lesions were detected before the primary focus in 45% of the cases. The authors conclude that metastatic disease should be considered in the differential diagnosis of eyelid lesions.
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Abstract
Two cases of carcinoma metastatic to the eyelid are described. The first was derived from a lung primary diagnosed two months prior and presented as a solitary tender mass mimicking an acutely inflamed recurrent chalazion. The second case was the initial manifestation of a stomach carcinoma, presenting as a solitary painless nodule. Both were part of generalized metastatic disease; survival was six weeks and five months, respectively, after eyelid tumor presentation. Excisional biopsy was effective palliation in the first case, but multiple operations were required in the second. The clinicopathologic features are discussed and the prior reported cases reviewed.
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Abstract
Frozen section diagnosis can afford the opportunity for histopathological examination of excised tissues in the operating room. Because frozen section techniques have traditionally been little used in ophthalmic surgery, many pathologists are not familiar with eye tissues. However, with cooperation and understanding between the ophthalmologist and the pathologist, frozen section diagnosis may be able to identify the tissue, the pathologic process and the extent of the lesion within 10-15 minutes. In this review, applications and problems of frozen section diagnosis in various types of ocular surgery are discussed.
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Char DH, Norman D. The use of computed tomography and ultrasonography in the evaluation of orbital masses. Surv Ophthalmol 1982; 27:49-63. [PMID: 6897128 DOI: 10.1016/0039-6257(82)90113-8] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
The combined use of computed tomography scans with multiplanar reformation and ultrasonography makes it possible to locate orbital masses with a high degree of accuracy, and sometimes even to determine their histological nature without surgical biopsy. One of the unique features of computed tomography is its ability to distinguish both normal and abnormal structures of various tissue densities; this has contributed to very low false positive and false negative rates. Ultrasonography, while of limited use in the detection of posterior orbital lesions or lesions involving the orbital bones, provides an excellent cost-effective screening test for anterior and midorbit disease. It is also useful for the detection of extraocular muscle enlargement secondary to thyroid disease. In this article, a review of the characteristics and techniques of computed tomography and ultrasonography is followed by discussion of the advantages and limitations of each modality in the evaluation of six common types of orbital tumefaction.
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