Georgakopoulos Constantinos D, Pallikari Athina, Plotas Panagiotis, Makri Olga E
Department of Ophthalmology, Medical School, University of Patras, Rio, 265 04 Patras, Greece.
Case Rep Urol. 2020 Dec 9;2020:8862203. doi: 10.1155/2020/8862203. eCollection 2020.
To present a case of clear cell renal cell carcinoma with late-onset bilateral choroidal metastases. . A 57-year-old male patient in the Oncology Clinic complained of reduced vision in the right eye (OD) for 7 days. The patient, who was under immunotherapy with nivolumab, had been diagnosed with clear cell renal cell carcinoma in the left kidney 15 years ago that recurred in the right kidney before 2 years. Metastases in the brain, lungs, and bones had also been diagnosed. On ophthalmological examination, the visual acuity was 20/50 OD and 20/20 in the left eye (OS). Dilated fundus examination in OD revealed a single raised oval-shaped yellowish choroidal nodule infratemporally with macular involvement. A similar lesion, sparing the macula, was observed in OS. Fundus autofluorescence revealed diffuse punctate hyperautofluorescence on the lesions. Serous macular detachment was also observed in OD. A standardized A-scan ultrasound demonstrated an irregular structure of the lesions with moderate to high internal reflectivity. Based on the history and clinical and echographic characteristics, the diagnosis of bilateral choroidal metastases from renal cell carcinoma was set.
Choroidal metastases from the primary renal tumor are extremely rare. The time interval between primary malignancy and choroidal metastasis is reported to be 12-96 months. Bilateral choroidal metastases have been described in 9 cases. We describe a rare case where bilateral choroidal metastases were diagnosed 15 years after the initial diagnosis of clear cell renal cell carcinoma.
报告一例透明细胞肾细胞癌伴迟发性双侧脉络膜转移的病例。一名57岁男性肿瘤门诊患者主诉右眼视力下降7天。该患者正在接受纳武单抗免疫治疗，15年前被诊断为左肾透明细胞肾细胞癌，2年前复发于右肾。还诊断出脑、肺和骨转移。眼科检查显示，右眼视力为20/50，左眼视力为20/20。右眼散瞳眼底检查发现颞下有一个单个隆起的椭圆形淡黄色脉络膜结节，累及黄斑。左眼观察到一个类似病变，但未累及黄斑。眼底自发荧光显示病变处有弥漫性点状高自发荧光。右眼还观察到浆液性黄斑脱离。标准化A超显示病变结构不规则，内部反射率为中到高。根据病史、临床和超声特征，诊断为肾细胞癌双侧脉络膜转移。
原发性肾肿瘤的脉络膜转移极为罕见。据报道，原发性恶性肿瘤与脉络膜转移之间的时间间隔为12 - 96个月。已有9例双侧脉络膜转移的报道。我们描述了一例罕见病例，在最初诊断透明细胞肾细胞癌15年后诊断出双侧脉络膜转移。
