Alasil Tarek, Khazai Bahram, Loredo Lilia, Rauser Michael E
Department of Ophthalmology, Loma Linda University, Loma Linda, CA 92354, USA.
J Med Case Rep. 2011 Aug 3;5:345. doi: 10.1186/1752-1947-5-345.
We report an unexpected presentation of metastatic renal cell carcinoma (RCC) to the ciliary body and an interesting response to proton beam radiotherapy.
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.
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.
我们报告了一例转移性肾细胞癌（RCC）意外转移至睫状体的病例，以及对质子束放疗的有趣反应。
我们遇到了一例闭角型青光眼，这是一名65岁白人男性眼部转移至睫状体的初始表现，该男性15年前因RCC接受了右肾根治性切除术。在进行进一步的转移灶检查时，他接受了钇铝石榴石（YAG）激光周边虹膜切开术。他的病情最终被诊断为透明细胞型IV期转移性RCC，累及多个部位，包括睫状体、脑、肺、肝和胰腺。对RCC转移至睫状体的进展情况进行了16个月的研究。尽管使用替西罗莫司和白细胞介素-2进行了全身治疗以及玻璃体内注射贝伐单抗，但睫状体肿块仍继续生长。在质子治疗开始前，肿瘤大小达到峰值6.11×6.06mm，质子治疗后肿瘤大小减小至5.07×4.39mm。
RCC在原发肿瘤切除多年后可发生转移至不常见部位。在其他治疗方式无效的情况下，发现质子治疗对治疗RCC转移至睫状体有效。
