Orbital metastasis of renal cell carcinoma masquerading as cysticercosis

Metastasis to the orbital soft tissues is relatively uncommon. We report a rare case of renal cell carcinoma with orbital metastasis as the first clinical manifestation. A 48-year-old-man presented with left proptosis and complete ptosis of three weeks duration. Radiological examination revealed a left intraconal heterogeneous cyst-like lesion with rim enhancement immediately deep to the left superior rectus muscle. Diagnosed as having orbital cysticercosis, he was prescribed oral albendazole and prednisolone. But there was no clinical improvement. An incisional biopsy performed showed metastatic poorly differentiated carcinoma. The patient complained of backache and weight loss in the interim. Magnetic resonance imaging (MRI) of the spine showed extensive vertebral metastasis to the thoracic and lumbosacral spine and the iliac bone, with an incidental detection of a large mass from the right kidney. Further MRI of abdomen and chest showed a large right renal mass presumed to be a renal cell carcinoma with extension into the right renal vein, intra-abdominal lymph nodes, and peritoneum. There were small nodules in the lung suggesting the possibility of pulmonary metastatic deposits. Renal cell carcinoma does not respond to chemotherapy, immunotherapy, or radiation; because of the disease's advanced stage, the patient received palliative treatment. There have been only two other reports in the literature of metastatic renal cell carcinoma in the orbit where the proptosis was the initial presenting feature similar to our case.