VITREOUS SEEDING OF RENAL CELL CARCINOMA IN A PATIENT RECEIVING CHECKPOINT INHIBITORS

To describe a case of vitreous seeding with tractional retinal detachment as a result of metastatic renal cell carcinoma in a patient on systemic checkpoint inhibitors.

Case report.

A 44-year-old Hispanic woman with a history of renal cell carcinoma with metastases to the lungs, adrenal glands, hilar lymph nodes, and peritoneum presented with a complaint of severe floaters and blurry vision of the right eye for two months. She was found to have dense, web-like vitreous opacities and a peripheral tractional retinal detachment of the right eye. Pars plana vitrectomy, membrane peeling, endolaser, air-fluid exchange, gas injection, and vitreous biopsy were performed. The vitreous and membranes were sent for cytology with stains, including AE1/AE3, PAX-8, CK-7, CA-IX, AMACR, and S-100. Cytology revealed crowded groups of glandular cells, some in papillary-like formations. Positive stains included AE1/AE3, PAX-8, CK-7, CA-IX, and AMACR.

Cytology and pathology demonstrated that vitreous seeding of metastatic renal cell carcinoma without an ocular mass lesion. It is hypothesized that the use of checkpoint inhibitors played a role in allowing for the atypical and previously unreported seeding of renal cell carcinoma to the vitreous.