Morra Rocco, D'Ambrosio Antonio, Pietroluongo Erica, De Placido Pietro, Montella Liliana, Del Deo Vitantonio, Tortora Marianna, Matano Elide, Damiano Vincenzo, Palmieri Giovannella, De Placido Sabino, Giuliano Mario
Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy.
Oncology Operative Unit, "Santa Maria delle Grazie" Hospital (ASL NA 2 NORD), Pozzuoli, Italy.
AME Case Rep. 2022 Oct 30;6:35. doi: 10.21037/acr-22-16. eCollection 2022.
Renal cell carcinoma (RCC) usually is characterized by a slow pattern of growth, although with an unpredictable evolution and metastatic potential, favored by its extensive vascularity and related high angioinvasive profile. The most common sites of metastases from kidney cancer are lung, lymph nodes, bone and liver; whereas orbital metastases are very uncommon. In more than 25% of cases, orbital metastases are the first manifestation of a primary tumor of unknown origin. The clinical features of orbital metastases from kidney cancer are non-specific and could divert attention from the real problem.
In this article, we describe the case of a 72-year-old male patient reporting a painful mass on the right orbit, with exophthalmos and ptosis, as the first and unique signs of a previously undetected advanced RCC. Due to the clinical conditions, the patient underwent palliative radiation therapy delivered to the orbital lesion with the scope to relieve pain; subsequently started systemic therapy with pazopanib at the dose of 800 mg daily. Unfortunately, he did not achieve any benefit from systemic therapy, his conditions progressively worsened, and he finally passed away after four months of treatment due to rapid disease progression.
Despite its rarity, differential diagnosis of an orbital lesion should always consider the possibility of metastasis from RCC, performing an appropriate radiological evaluation.
肾细胞癌（RCC）通常具有生长缓慢的特点，但其发展和转移潜力难以预测，这得益于其丰富的血管分布和较高的血管侵袭性。肾癌最常见的转移部位是肺、淋巴结、骨和肝；而眼眶转移则非常罕见。在超过25%的病例中，眼眶转移是原发肿瘤不明的首发表现。肾癌眼眶转移的临床特征不具有特异性，可能会分散对实际问题的注意力。
在本文中，我们描述了一名72岁男性患者的病例，该患者报告右眼眶有一个疼痛性肿块，并伴有眼球突出和上睑下垂，这是先前未被发现的晚期肾细胞癌的首发且唯一症状。由于临床情况，患者接受了姑息性放射治疗，照射眼眶病变以缓解疼痛；随后开始使用帕唑帕尼进行全身治疗，剂量为每日800毫克。不幸的是，他未从全身治疗中获得任何益处，病情逐渐恶化，最终在治疗四个月后因疾病快速进展而去世。
尽管眼眶病变罕见，但在鉴别诊断时应始终考虑肾细胞癌转移的可能性，并进行适当的放射学评估。
