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Case Reports
. 2022 Oct 30:6:35.
doi: 10.21037/acr-22-16. eCollection 2022.

The unusual first sign of presentation of renal cell carcinoma: a rare case report

Rocco Morra #  1 , Antonio D'Ambrosio #  1 , Erica Pietroluongo  1 , Pietro De Placido  1 , Liliana Montella  2 , Vitantonio Del Deo  3 , Marianna Tortora  3   4 , Elide Matano  1   3 , Vincenzo Damiano  1   3 , Giovannella Palmieri  4 , Sabino De Placido  1   3   4 , Mario Giuliano  1   3   4
Affiliations
Case Reports

The unusual first sign of presentation of renal cell carcinoma: a rare case report

Rocco Morra et al. AME Case Rep. .

Abstract

Background: Renal cell carcinoma (RCC) usually is characterized by a slow pattern of growth, although with an unpredictable evolution and metastatic potential, favored by its extensive vascularity and related high angioinvasive profile. The most common sites of metastases from kidney cancer are lung, lymph nodes, bone and liver; whereas orbital metastases are very uncommon. In more than 25% of cases, orbital metastases are the first manifestation of a primary tumor of unknown origin. The clinical features of orbital metastases from kidney cancer are non-specific and could divert attention from the real problem.

Case description: In this article, we describe the case of a 72-year-old male patient reporting a painful mass on the right orbit, with exophthalmos and ptosis, as the first and unique signs of a previously undetected advanced RCC. Due to the clinical conditions, the patient underwent palliative radiation therapy delivered to the orbital lesion with the scope to relieve pain; subsequently started systemic therapy with pazopanib at the dose of 800 mg daily. Unfortunately, he did not achieve any benefit from systemic therapy, his conditions progressively worsened, and he finally passed away after four months of treatment due to rapid disease progression.

Conclusions: Despite its rarity, differential diagnosis of an orbital lesion should always consider the possibility of metastasis from RCC, performing an appropriate radiological evaluation.

Keywords: Case report; orbital metastasis; renal carcinoma; undiagnosed cancer.

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Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://acr.amegroups.com/article/view/10.21037/acr-22-16/coif). SDP reports consulting fees for Consulting or advisory Role: GSK, MSD, Seagen, Daiichi Sankyo, Lilly, Clovis, Celgene, Astrazeneca, Novartis, Pfizer, Roche; and Speaker’s Bureau: Celgene, Astrazeneca, Novartis, Pfizer, Roche. MG reports consulting fees for Consulting or advisory Role: Astrazeneca, MSD, Seagen, Daiichi Sankyo, Lilly, Celgene, Novartis, Pfizer; Speaker’s Bureau: Lilly, Celgene, Novartis, Pfizer, Istituto Gentili, Eisai Europe Ltd., Roche; Travel, accommodation, expenses: Novartis, Pfizer, Roche. The other authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Patient’s clinical appearance at the first presentation, showing right palpebral ptosis and exophthalmos. This image is published with the patient’s daughter’s consent.
Figure 2
Figure 2
Ocular ultrasonography of the right eye. Red circles show a large mass arising from the lacrimal gland, reaching the temporal lobe.
Figure 3
Figure 3
Cranio-facial computed tomography scan (CT scan) showing the lesion located at the upper outer portion of right orbit, with bone erosion, muscle and pachymeningeal infiltration.
Figure 4
Figure 4
Coronal fusion images of 18F-FDG PET/CT scan showing 18 F-FDG uptake in the right orbit, multiple FDG-positive pulmonary nodules, bone metastasis and a lesion with a maximum diameter of 50 mm in the right kidney. 18F-FDG PET/CT, 18-fluorodeoxyglucose-positron emission tomography/computerized tomography.
Figure 5
Figure 5
Hematoxylin and eosin staining. Magnification ×2.
Figure 6
Figure 6
Immunohistochemical staining for RCC-Ma. Magnification ×2.8. RCC-Ma, renal cell carcinoma marker.
Figure 7
Figure 7
Immunohistochemical staining for PAX8. Magnification ×2. PAX8, paired-box gene 8.
See this image and copyright information in PMC

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