Vitreous Seeding of Renal Cell Carcinoma in a Patient Receiving Checkpoint Inhibitors.

Abstract

To describe a case of vitreous seeding with tractional retinal detachment due to metastatic renal cell carcinoma (RCC) in a patient on systemic checkpoint inhibitors. Case Report. A 44-year-old Hispanic woman with a history of RCC with metastases to the lungs, adrenal glands, hilar lymph nodes, and peritoneum presented with a complaint of severe floaters and blurry vision of the right eye for two months. She was found to have dense, web-like vitreous opacities and a peripheral tractional retinal detachment of the right eye. We performed a pars plana vitrectomy, membrane peeling, endolaser, air-fluid exchange, gas injection, and vitreous biopsy. The vitreous and membranes were sent for cytology with stains including AE1/AE3, PAX-8, CK-7, CA-IX, AMACR, and S-100. Cytology revealed crowded groups of glandular cells, some in papillary like formations. Positive stains included AE1/AE3, PAX-8, CK-7, CA-IX, and AMACR. Cytology and pathology demonstrated that vitreous seeding of metastatic RCC without an ocular mass lesion. We hypothesize that the use of checkpoint inhibitors played a role in allowing for the atypical and previously unreported seeding of RCC to the vitreous.