Abstract
Orbital metastasis from renal cell carcinoma (RCC) is uncommon. Orbital tumor, as the first presentation of RCC, is rare as the majority of orbital metastases occur after a confirmed diagnosis of primary cancer. We report a case of the metastatic orbital tumor as the first manifestation of RCC, which presented with painless left eye proptosis for two months' duration, associated with blurring of vision and diplopia. Otherwise, the systemic review was unremarkable. Examination showed left eye non-axial proptosis with a pulsatile, multilobulated mass over the left supraorbital area extending to the left frontal region, limited ocular motility, and impaired optic nerve functions. CT of the orbit showed a mass arising from the left frontal and greater wing of the left sphenoid bone, with infiltration to the left lateral rectus, left superior oblique, and lacrimal gland. Further systemic investigation with CT thorax, abdomen, and pelvis revealed left RCC with para-aortic nodes, lungs, and bone metastases. The patient was planned for palliative care.
Highlights
Metastasis to the eye most commonly involves the uvea, especially the choroid, attributing to its vast blood supply [1]
We report a case of an orbital tumor presenting as the first manifestation of metastatic renal cell carcinoma (RCC)
The majority of orbital metastases occur after a confirmed diagnosis of primary cancer, only 25% present as the first manifestation of metastatic cancers
Summary
Metastasis to the eye most commonly involves the uvea, especially the choroid, attributing to its vast blood supply [1]. The metastatic nature of an atypical orbital tumor should be considered even in those without a cancer history. We report a case of an orbital tumor presenting as the first manifestation of metastatic renal cell carcinoma (RCC). The systemic review was unremarkable with no loss of appetite or weight, haematuria, flank pain, cough, or bony pain She was a cigarette smoker of eight packs/year. Due to high suspicion of metastatic nature of the orbital tumor, systemic surveillance with CT was done, which revealed a stage four left RCC with para-aortic nodes, lungs, and bone metastases (Figure 4). A clinical diagnosis of left metastatic orbital tumor secondary to RCC was made. She refused biopsy for histopathological confirmation, surgery, chemotherapy or radiotherapy, and opted for palliative care
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