Renal Cell Carcinoma Metastasis to an Uncommon Site: The Orbital Bone

Abstract

Renal cell carcinoma (RCC) represents 90% of all renal cancers. Patients may present with weight loss, hematuria, abdominal mass, abdominal pain, fever, and night sweats. The classic symptoms of flank pain, hematuria, and a palpable flank mass occur in less than 10% of patients and suggest advanced disease. However, most patients are typically asymptomatic and diagnosed incidentally. RCC metastasizes most commonly to the lung parenchyma, bone, liver, and brain and less commonly to the thyroid, pancreas, muscle, skin, and soft tissue. It is very rare for RCC to metastasize to the orbital bone. We present a case of a patient who presented with left cheek pain, tingling, and numbness and was ultimately found to have orbital metastasis of RCC.

Keywords: metastatic renal cell carcinoma; orbital mass; orbital metastasis.

Figure 1. Upright chest X-ray revealing a dense airspace opacity at the left lung base (white arrow) suggestive of pleural effusion.

Figure 2. Chest CT scan with contrast revealing mediastinal adenopathy (yellow arrow) and numerous spiculated nodules of various sizes scattered throughout both lungs (red arrows).

CT: Computed tomography

Figure 3. Axial T1 MRI of the brain with contrast revealing a 4.3 cm enhancing mass (red arrow) in the left anterior temporal and lateral orbital wall.

MRI: Magnetic resonance imaging

Figure 4. Axial T1 MRI of the brain with contrast from 2014 showing no acute intracranial abnormalities or masses.

MRI: Magnetic resonance imaging