By Paul T. Finger, MD
History
This 45 year old HIV positive patient was noted decreased vision in his left eye for 3 weeks duration. He had a past medical history of renal cell carcinoma with lung metastasis.
Impression
Choroidal Metastasis: of Renal Cell Carcinoma Origin
Treatment
This risks and benefits of chemotherapy and external beam radiation therapy were discussed in detail. Though he was to receive systemic chemotherapy, external beam irradiation was initiated due to the severity of his disease.
Comment
This case presents multiple findings consistent with metastatic choroidal tumors: uveal mass and secondary retinal detachment. Multifocality and bilaterality can also be noted.
The presence of metastatic tumor in his lungs was a risk factor for uveal extension. All patients with intraocular metastasis should undergo radiographic imaging of their head, chest, and abdomen or total body PET/CT.
This case is unusual in that the most common primary cancers are breast in women and lung in men. Choroidal metastasis of renal cell origin are relatively rare.
In this case, our patient presented with a known primary cancer. Eighteen percent of patients will present with no known primary, most will have their primary discovered by subsequent systemic evaluations, and a few will have to undergo ocular fine-needle aspiration biopsy to help determine its source
