Choroidal metastases from renal carcinoma are rare. Most reported cases describe a clear cell carcinoma histologic subtype. Metastatic tubulopapillary renal cell carcinoma to the choroid plexus is very exceptional

Elghissassi, Ibrahim

Errihani, Hassan

Inrhaoun, Hanane

Ismaili, Nabil

English

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Case report
Open Access
Choroidal metastasis from tubulopapillary renal cell carcinoma:
a case report
Ibrahim Elghissassi*, Hanane Inrhaoun, Nabil Ismaili and Hassan Errihani
Address: Department of Medical Oncology, National Institute of Oncology, Rabat, Morocco
Email: IE* - i_elghissassi@hotmail.com; HI - in_hanane@yahoo.fr; NI - Nabil@yahoo.fr; HE - h_errihani@yahoo.fr
*Corresponding author
Received: 21 March 2009 Accepted: 30 May 2009 Published: 29 June 2009
Cases Journal 2009, 2:6681 doi: 10.4076/1757-1626-2-6681
This article is available from: http://casesjournal.com/casesjournal/article/view/6681
© 2009 Elghissassi et al; licensee Cases Network Ltd.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0),
which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
Choroidal metastases from renal carcinoma are rare. Most reported cases describe a clear cell
carcinoma histologic subtype. Metastatic tubulopapillary renal cell carcinoma to the choroid plexus is
very exceptional.
We report the case of a 31-year-old man with a history of tubulopapillary renal cell carcinoma who
presented two years later with metastatic disease to lungs and presternal soft tissue and three
months after with choroidal metastasis revealed on ophtalmoscopic examination and magnetic
resonance imaging.
The case is discussed in the framework of the existing literature about the clinical features, treatment,
and prognosis of this very rare condition.
Introduction
Kidney cancer accounts for approximately 2.5% of all
adult cancers. Clear cell carcinoma is the most common
histologic subtype followed by tubulopapillary renal cell
carcinoma (TPRCC) who represents about 10% of all renal
cell tumours [1]. This tumor metastasizes most frequently
to lung, liver, bone, and subcutaneous tissues. Choroidal
metastasis from TPRCC is extremely rare. The present
study describes a case of choroidal metastasis from a
TPRCC.
Case presentation
A 31-year-old Berber Moroccan man was admitted in June
2005 for investigation of painless haematuria. His medical
history was otherwise unremarkable. A suspicious left
kidney mass was discovered and the patient underwent left
radical nephrectomy. Pathological examination reported
‘moderately differentiated’ TPRCC. The tumour was
confined to the pelvis, with no evidence of distant
metastases at this stage.
Two years later, he presented with a rapidly growing mass
located on midline anterior chest wall (Figure 1). Thoracic
CT-scan showed irregularity and sclerosis of lower part of
sternum with a large presternal soft tissue mass and
multiple opacities throughout both lung fields consistent
with pulmonary metastases. A radionuclide bone scan
revealed a single area of uptake of radiotracer in the
sternum. Abdominopelvic CT-scan was normal. Routine
hematological, liver function and renal function tests
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were within normal ranges. A biopsy of the mass was
performed and histopathological examination confirmed
the diagnosis of metastatic TPRCC.
The patient received medical treatment which included
interferon alfa-2a (9 MIU subcutaneously three times
weekly) and bevacizumab (10 mg/kg every 2 weeks). After
three months of this treatment, a repeat thoracic and
abodminopelvic CT scan demonstrated a progressive
disease with increasing of the presternal mass by 40%
and appearance of multiple liver metastases. Furthermore,
the patient developed severe headaches and blurred vision
in the left eye. Ophthalmoscopic examination of the left
eye showed a yellow choroidal mass, measuring about half
a disc diameter and located below and lateral to the
macular area, which was highly characteristic of choroidal
metastasis. Cerebral magnetic resonance imaging was
performed and showed a left lateral choroidal mass with
secondary retinal detachment. This radiological aspect was
consistent with the diagnosis of choroidal metastasis
(Figure 2). Radiation therapy was begun to the left eye,
but the patient’s condition deteriorated rapidly and he
died two weeks later.
Discussion
The first choroidal metastasis case was described by Perl in
1872 [2]. Godtfredsen, reported a 0.07% incidence of
clinically detected choroidal metastasis in patients with
systemic malignancy in 1944 [3]. Since then, the reported
incidence of choroidal metastasis has been increasing
related to advances in ophthalmic diagnostic techniques
and the treatment of systemic cancers [4].
Although breast and lung cancers represent the most
common source of choroidal metastases, malignancies of
the gastrointestinal tract, kidney, prostate and skin have all
been reported to metastasize to the choroid [5]. Most
reported cases of metastasis to the choroid plexus from
renal cell carcinoma describe a clear cell carcinoma
histologic subtype. The mechanism of this association is
still unclear. Choroidal metastasis from TPRCC, as in our
case, remains very exceptional [6].
Clinically, the most common symptoms are blurring of
vision, photopsia, floaters and pain whereas some patients
may be asymptomatic. Typical ophtalmoscopic features
include one or multiples creamy yellow choroidal lesions
associated in some advanced cases with secondary retinal
detachment [7].
In patients with metastatic cancer to the choroids, the most
appropriate treatment seems to be a course of external
beam radiation therapy. Radiotherapy can improve vision
with a high response rate (63-89%) [8] and prevent pain
and secondary glaucoma [9]. Systemic chemotherapy or
hormonotherapy may be effective to controle choroidal
metastasis with 26-81% tumor control rate reported
[10,11]. In cases of painful blind eye, enucleation may
be considered [12].
The prognosis for choroidal metasatsis is generally poor.
The median survival was found to be as short as 8 months
after the onset of metastatic disease [13].
Choroidal metastasis from renal carcinoma is a rare
condition that should not be overlooked. A high index
of suspicion and adequate investigation of patients with
visual complaints and history of renal carcinoma are
needed.
Figure 1. A midline anterior chest wall mass. Figure 2. A left lateral choroidal mass with secondary retinal
detachment on magnetic resonance imaging.
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Cases Journal 2009, 2:6681 http://casesjournal.com/casesjournal/article/view/6681
Abbreviations
TPRCC, Tubulopapillary renal cell carcinoma; CT,
Computed tomography.
Consent
Written informed consent was obtained from the patient’s
wife for publication of this case report. A copy of the
written consent is available for review by the Editor-in-
Chief of this journal.
Competing interests
The authors declare that they have no competing interests.
Authors’ contributions
IE and HI were major contributors in writing the manu-
script. NI and HE involved in revising the manuscript. All
authors read and approved the final manuscript.
References
1. Sibony M, Vieillefond A: Non clear cell renal cell carcinoma.
2008 update in renal tumor pathology. Ann Pathol 2008, 28:381-
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2. Perl M: Contributions to pathology of tumours. Virchow’s Arch
Pathol Anat 1872, 56:445-448.
3. Godtfredsen E: On frequency of secondary carcinoma of
choroid. Acta Ophthalmol 1944, 22:394-400.
4. Bloch RS, Gartner S: The incidence of ocular metastatic
carcinoma. Arch Ophthalmol 1971, 85:673-675.
5. Shields CL, Shields JA, Gross NE, Schwartz GP, Lally SE: Survey of
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6. Kadrian D, Tan L: Single choroid plexus metastasis 16 years
after nephrectomy for renal cell carcinoma: case report and
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7. Soysal HG: Metastatic tumors of the uvea in 38 eyes. Can J
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Curran WJ Jr: External beam irradiation for choroid metas-
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10. Demirci H, Shields CL, Chao A, Shields J: Uveal metastasis from
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11. Soysal HG: Metastatic tumors of the uvea in 38 eyes. Can J
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Choroidal metastasis from tubulopapillary renal cell carcinoma: a case report

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