Choroidal metastasis as the first manifestation of renal pelvis carcinoma: A case report

Abstract

Rationale: Choroidal metastasis is an uncommon event, especially as the first sign of renal pelvis carcinoma (RPC), a rare subtype of upper tract urothelial carcinoma (UTUC). While the majority of choroidal metastases originate from primary cancers like breast or lung, those arising from urologic cancers are extremely rare. This article describes a case of RPC where the first clinical sign was a choroidal mass.

Patient concerns: A 51-year-old female presented with a 2-week history of decreased vision in her left eye (OS). She reported no prior history of malignancy or significant family history of cancer. Examination revealed retinal detachment and a reddish-white, dome-shaped choroidal lesion. Multimodal imaging, including indocyanine green angiography, Doppler ultrasound, optical coherence tomography confirmed the metastatic nature of the mass.

Diagnoses: Magnetic resonance imaging, computed tomography and whole-body bone scintigraphy with 99mTc-MDP detected multiple metastases to the brain, lungs, and bone, with primary RPC in the left renal pelvis. These findings led to the diagnosis of metastatic RPC.

Interventions: Given the advanced disease stage and poor prognosis, the patient declined invasive treatments such as biopsy or systemic chemotherapy.

Outcomes: Two weeks after diagnosis, the patient succumbed to rapid disease progression.

Lessons: This is a unique case of RPC presenting with tetra-organ metastases involving the lung, bone, brain, and choroid. It underscores the need for a comprehensive systemic evaluation in patients with unexplained choroidal masses, as these may be indicative of an underlying, often asymptomatic, systemic malignancy. Further therapeutic studies are essential to explore effective management strategies and improve outcomes for similar patients with RPC.

Keywords: case report; choroidal metastasis; renal pelvis carcinoma; retinal detachment.

Figure 1.

Fundoscopy, ICGA, Doppler ultrasound and OCT examinations of the patient at presentation. Ultra-wide-field fundus photography showed inferior retinal elevation and a dome-shaped, reddish-white choroidal mass nasal to the optic disc (A). ICGA showed early-stage mottled hyper- and hypofluorescence in the nasal region (B), with late-stage diffuse hyperfluorescence interspersed with areas of hypofluorescence, accompanied by leakage (C). Doppler ultrasound identified a nasal choroidal mass with a basal diameter of 14.0 mm and a thickness of 0.42 mm, exhibiting abundant blood flow signals (D). OCT revealed choroidal elevation, significant compression of the choriocapillaris, and disruption of the photoreceptor layer (E). ICGA = indocyanine green angiography, OCT = optical coherence tomography.

Figure 2.

Multiple examinations showed malignancies in the orbit, brain, lung and bone. MRI presented a nasal choroidal tumor (A, green arrow) and an intracranial mass in the left parietal lobe (B, yellow arrow). Chest CT demonstrated multiple pulmonary nodules (C). Whole-body bone scintigraphy with 99mTc-MDP showed increased radiotracer uptake in the L4 vertebra (D, red arrow). CT = computed tomography, MRI = magnetic resonance imaging.

Figure 3.

Renal pelvis carcinoma identified by ultrasound and CT scan. Ultrasound revealed the neoplasm in the left renal pelvis (A). Contrast-enhanced abdominal CT showed left adrenal involvement in the arterial phase (B), a tumor in the left renal pelvis in both the non-contrast phase (C) and arterial phase (D), and adjacent lymph node involvement in the non-contrast phase (E) and arterial phase (F). Additionally, a tumor thrombus was identified in the renal vein during the venous phase (G). The tumor is indicated by the red arrow. CT = computed tomography.