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Visual disturbance due to choroidal metastasis as the first clinical sign of renal carcinoma, a case report

A 46-year-old man presented to the ophthalmology department with a left eye visual disturbance, specifically metamorphopsy, with no other systemic symptoms. Standard ophthalmologic examination showed reduced visual acuity of the left eye measuring 0.3 (cc +1, 00 dsph), with normal right eye visual acuity. Ocular motility and bio- microscopy were normal in both eyes. Left eye fundus examination revealed a yellow lesion on the macular with serous retinal detachment, suggestive of a choroidal tumor. Fluorescein angiography, confirms a choroidal tumor of metastatic origin. Since the patient did not present with any systemic symptoms, initially the primary tumor was unknown. Clinical and diagnostic examination was done in order to find the primary tumor. MDCT of the abdomen and thorax was performed. The lungs showed multiple enlarged and necrotic lymph nodes on both sides with multiple paranchymal and interstitial nodules of similar size in both lungs which were radiologically corresponded to metastatic lesions. Additionally, metastatic osteolitic lesions on the inferior margins of the right scapula and thoracic spine were also present. The right kidney was enlarged and almost entirely infiltrated by an inhomogeneous and irregular necrotic tumor mass, which radiologically corresponded as the primary tumor site. The tumor infiltrated the right renal sinus. There was no renal vein thrombosis, but a channel system of the upper and medium calices and renal pelvis was infiltrated by tumor tissue. Additionally, the patient presented with skin changes, which were biopsied and analyzed pathologically. Immunohistochemistry of the skin sample confirmed that the tumor was not of epidermal origin . It was composed of abortive glandular structures and solid areas which were positive for the CK7 marker and negative for theCK20, CK5/6 and TTF-1 markers.CK7 is a keratin marker often expressed in adenocarcinoma, including adenocarcinoma of the lungs as well as several histological types of renal carcinoma. A transbronchial lung biopsy was also performed and the biopsied sample was also positive for the CK7 marker (figure 6) and negative for the TTF-1 marker which is often the case for lung adenocarcinoma . Both tissue samples were also negative for several renal cell carcinoma markers, such as vimentine and CD10. According to these findings an oncologist prescribed an appropriate chemotherapy protocol of cisplatin-etopozid. The patient died after only one chemotherapy cycle and subsequently a renal biopsy was not performed.

choroidal metastasis ; visual disturbancem ; renal carcinoma

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