Choroidal Melanoma Mimicker: A Case of Metastatic Clear-Cell Renal Cell Carcinoma

Komanski, Chris B.; Rubino, Shaina M.; Meyer, Jacob C; Greven, Craig M.

doi:10.1159/000462975

Cited by 3 publications

(2 citation statements)

References 13 publications

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“…Also, 19 patients (17.9%) had only ocular metastasis. [ 2 , 6 , 7 , 11 , 13 , 24 , 16 , 25 , 27 , 30 - 32 , 42 , 45 , 51 , 54 , 56 ] There was no other distant metastasis seen in such cases. Therefore, screening of eyes with regular follow-up should be advised for all the patients diagnosed with RCC, especially clear cell variant for the early diagnosis of metastasis.…”

Section: Discussionmentioning

confidence: 88%

Ocular metastasis from renal malignancies – A comprehensive review

Jindal,

Kapatia,

Gupta

2023

Indian Journal of Ophthalmology

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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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Section: Discussionmentioning

confidence: 88%

Ocular metastasis from renal malignancies – A comprehensive review

Jindal,

Kapatia,

Gupta

2023

Indian Journal of Ophthalmology

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“…Therefore, IOM should not be neglected in follow-up surveillance of patients who have received treatment for RCC [ 29 ]. Intraocular mRCC within the choroid is the most common form of IOM and may exhibit a similar clinical appearance to that of uveal melanoma [ 30 ]. Metastases to the iris and the ciliary body are comparatively uncommon in patients with RCC and tend not to be detected in clinical practice except existing a history or clinical certification of systemic malignancy [ 31 ].…”

Section: Discussionmentioning

confidence: 99%

Neuron-Specific Enolase and Hemoglobin as Risk Factors of Intraocular Metastasis in Patients with Renal Cell Carcinoma

Shi

et al. 2022

Disease Markers

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Renal cell carcinoma (RCC) appears to be a high risk of spread. This research investigated the correlation between a different range of clinical features and intraocular metastasis (IOM) in RCC patients and attempted to determine potential risk factors of RCC patients with IOM. In the study, there are a total of 351 patients with RCC that were recruited between May 1994 and May 2016. The differences between RCC patients with IOM and RCC patients with non-IOM (NIOM) were evaluated by the chi-squared test and Student t test. Binary logistic regression analysis was applied to determine risk factors. Finally, the value of diagnosis for RCC patients with IOM was assessed by receiver operating characteristic (ROC) curve analysis. Eighteen individuals were identified with IOM. There were no significant differences that were detected in alkaline phosphatase (AFP), carcinoembryonic antigen (CEA), alkaline phosphatase (ALP), cancer antigen 125 (CA-125), cancer antigen 153 (CA-153), cancer antigen 199 (CA-199), calcium, age, primary tumor site, and histopathological subtypes between the two groups. But there was a difference in terms of gender ( P < 0.05 ). The IOM group exhibited significantly higher neuron-specific enolase (NSE) and lower hemoglobin (Hb) values compared to the NIOM group ( P < 0.05 , respectively). Binary logistic regression identified NSE and Hb as significant risk factors of IOM for RCC patient ( P < 0.05 and P < 0.001 , respectively). The ROC curve analysis indicated that the area under the curve (AUC) values of NSE and Hb were 0.694 and 0.749, while cut-off values were 49.5 ng/mL and 102.5 g/L, respectively. The sensitivity and specificity of NSE were 72.2% and 66.4%, respectively, while those of Hb were 72.2% and 74.2%, respectively. The result reveals that NSE and Hb represent promising significant risk factors of IOM for RCC patients. Notably, Hb is more reliable than NSE in distinguishing case of IOM from NIOM in patients with RCC.

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Sudden Vision Loss in a Patient With Renal Cell Carcinoma: A Potential Indicator of Choroidal Metastasis

Kührer,

Haas,

Wafa

et al. 2024

Cureus

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Choroidal metastasis of renal cell cancer (RCC) is an exceptionally rare clinical occurrence. In most cases, sudden vision loss is the first symptom. Here we present the case of a 52-year-old male with papillary RCC first diagnosed in 2018. Three years later, a bronchoscopy with endobronchial ultrasound (EBUS) identified suspicious infracarinal lymph nodes. A biopsy confirmed metastasis from RCC, leading to the initiation of systemic first-line therapy with cabozantinib monotherapy. The patient confirmed an excellent response with complete remission. In 2023, the patient reported for the first time a bilateral decrease in vision. Initial management with corrective lenses was unsuccessful. Further staging indicated metastases in the liver, spleen, and adrenal gland. Consecutively, the therapy was switched to lenvatinib and pembrolizumab. Two months later, an ophthalmologic examination due to persisting vision loss confirmed bilateral choroidal metastases. The systemic therapy was continued, and the patient's vision significantly improved. In 2024, the patient developed immune-associated pneumonitis, initially treated with prednisolone. The pulmonary situation became worse. A CT scan confirmed additional metastases in the lung with lymphangiosis carcinomatosis. Due to a poor performance status, no further systemic therapy has been initiated to date. In conclusion, this case highlights the rarity of choroidal metastases in RCC and the challenges of diagnosis. Ophthalmologic examination in RCC patients experiencing sudden vision loss is essential to detect these specific metastases as soon as possible. Comprehensive documentation and awareness of these rare metastatic manifestations are essential to improving diagnostic accuracy and patient outcomes.

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Choroidal Melanoma Mimicker: A Case of Metastatic Clear-Cell Renal Cell Carcinoma

Cited by 3 publications

References 13 publications

Ocular metastasis from renal malignancies – A comprehensive review

Ocular metastasis from renal malignancies – A comprehensive review

Neuron-Specific Enolase and Hemoglobin as Risk Factors of Intraocular Metastasis in Patients with Renal Cell Carcinoma

Sudden Vision Loss in a Patient With Renal Cell Carcinoma: A Potential Indicator of Choroidal Metastasis

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