J Korean Ophthalmol Soc.  2012 Jun;53(6):880-885.

A Case of Choroidal Metastasis from Renal Cell Carcinoma

• Park S
• Choi SY
• Choi KS

Abstract

PURPOSE
To report a rare case of choroidal metastasis from renal cell carcinoma.
CASE SUMMARY
A 61-year-old man visited our clinic with the chief complaint of decreased vision in the right eye. Three years earlier, he underwent right nephrectomy due to renal cell carcinoma. Best corrected visual acuity was 0.2 in the right eye and 1.0 in the left eye. Fundoscopic examination of the right eye revealed a yellowish, dome-shaped elevated choroidal mass with serous retinal detachment, measuring 5.0 x 4.0 disc diameter and located lateral to the macular area. Systemic evaluations showed multiple lung and brain metastases. A diagnosis of choroidal metastasis from renal cell carcinoma was made for the right eye, and the patient received local treatments with oral sorafenib therapy, composed of subtenon triamcinolone injection and intravitreal ranibizumab injection. Tumor progression continued, and visual acuity declined to hand motion. Enucleation was recommended, but the patient refused and is on a regular follow-up after transpupillary thermotherapy.
CONCLUSIONS
Ocular manifestation may be the initial presenting sign of a recurrent tumor, and an extensive systemic evaluation for metastatic malignancy should be performed. The present example showed a rare case of choroidal metastasis from renal cell carcinoma.

Keyword

Choroidal metastasis; Renal cell carcinoma

MeSH Terms

Antibodies, Monoclonal, Humanized
Brain
Carcinoma, Renal Cell
Choroid
Eye
Follow-Up Studies
Hand
Humans
Lung
Middle Aged
Neoplasm Metastasis
Nephrectomy
Niacinamide
Phenylurea Compounds
Retinal Detachment
Triamcinolone
Vision, Ocular
Visual Acuity
Ranibizumab
Antibodies, Monoclonal, Humanized
Niacinamide
Phenylurea Compounds
Triamcinolone

Figure

• 

  Figure 1 (A) Fundus photograph revealed a yellowish, dome-shaped elevated choroidal mass in the temporal posterior pole of the right eye, measuring 5.0 × 4.0 disc diameter. Overlying serous retinal detachment was also found. (B) Ultrasonography of the right eye showed a highly echogenic choroidal mass with moderate to high internal reflectivity, measuring 5.0 mm in height. (C) Fundus photograph 9 months after first diagnosis revealed the progression of choroidal mass with a massive serous retinal detachment in spite of transpupillary thermotherapy. (D) Ultrasonography 1 year after first diagnosis showed an enlarged choroidal mass extending to the posterior surface of lens.

• 

  Figure 2 Fluorescein angiography showed generalized hypofluorescence corresponding to choroidal mass lesion in the venous phase (A), mild mottled hyperfluorescence in the recirculation phase (B) and diffuse staining of choroidal mass lesion in the late phase (C).

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  Figure 3 A serous retinal detachment involving the macula and an elevated retinal pigment epithelial layer in both horizontal (A) and vertical (B) optical coherence tomography scans, which were described in (C). Topography map showed a diffuse temporal thickening involving the macula (D).

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