A Case Report of Choroidal Metastasis from Renal Cell Carcinoma during Sunitinib Treatment: A Tumor “Pharmacologic Sanctuary”?

Abstract

Background: Choroidal metastasis from Renal Cell Carcinoma (RCC) is very rare and only one case during Sunitinib treatment has been published until now. Case presentation: In February 2015, a 61-year old, Caucasian man was hospitalized for acute dyspnea. In 2006, he underwent right nephrectomy for clear-cells RCC. Chest CT-scan showed multiple lung and lymph node metastases. Histological examination confirmed metastasis from clear-cells RCC. According to Motzer and Heng classification, the patient was classified as intermediate risk and, from March to July 2015, he received a total of 3 cycles of Sunitinib treatment. Despite a relevant tumor response in lung and lymph node metastases, he presented a brutally, unexplained, blurred vision in his right eye secondary to a choroidal metastasis. An external radiotherapy was administered without any relevant, clinical benefit. Considering tumor response in the other metastatic sites, Sunitinib treatment was continued and it is now ongoing. Conclusion: RCC-associated choroidal metastasis is extremely rare. In contrast with another case responding to Sunitinib therapy, our patient presented a significant tumor response to Sunitinib in the extraocular metastatic sites and a choroidal progression, suggesting that the choroid could be a potential tumor “pharmacologic sanctuary” for this drug. This case also raises the question of how to treat patients presenting an isolated disease progression in the sites which are very difficult to be reached by systemic treatment.