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Ocular metastasis from renal malignancies - A comprehensive review
Akriti Jindal1, Gargi Kapatia1, Gaurav Gupta2
1Department of Pathology, All India Institute of Medical Sciences, Bathinda, Punjab, India.
Abstract:
The most common cause of intraocular mass is metastasis from other tumors. Renal malignancies, though rare, have a substantial number of cases with ocular metastasis, few of which were misdiagnosed. Many a times renal malignancies present with ocular manifestations before the primary diagnosis. Here in this article, we comprehensively reviewed 106 cases of ocular metastasis from renal malignancies published till date to the best of our knowledge. The eye is a rare site for distant metastasis because of the lack of a lymphatic system. The most common ocular structures to get involved in distant metastasis are the uveal tract, i.e., choroid, iris, and ciliary body. The most common renal tumor which metastasizes to eyes is renal cell carcinoma (RCC). RCC accounts for less than 2% of all ophthalmic metastases. Out of total 106 cases, the type of renal malignancy was known in 95 cases only, of which 92 had RCC, 1 Wilm's tumor, 1 rhabdoid tumor, and 1 medullary carcinoma. The age ranged widely from 2 weeks old to 81 years old. The male to female ratio was 3.4:1. In total, 67.4% of cases had a previous history of RCC, while the rest 32.6% primarily presented with ophthalmic manifestations first. Treatment modalities included enucleation of the eye, debulking surgery followed by radiotherapy and/or chemotherapy and/or immunotherapy.
Insights
Ocular metastasis from renal malignancies, particularly renal cell carcinoma (RCC), is rare but can present before primary diagnosis. This review of 106 cases highlights treatment options for these rare eye tumors.
Area of Science:
- Ophthalmology
- Oncology
- Nephrology
Background:
- Intraocular masses are often metastatic, with renal malignancies being a rare but significant cause.
- Ocular metastasis from renal tumors can precede the diagnosis of the primary malignancy.
- The eye's lack of a lymphatic system makes it an uncommon site for distant metastasis.
Purpose of the Study:
- To comprehensively review cases of ocular metastasis from renal malignancies.
- To analyze the demographics, clinical presentation, and treatment of these rare ophthalmic conditions.
Main Methods:
- Systematic review of 106 published cases of ocular metastasis from renal malignancies.
- Analysis of tumor types, patient demographics, presentation, and treatment modalities.
Main Results:
- Renal cell carcinoma (RCC) was the most common renal malignancy metastasizing to the eye (92 out of 95 known cases).
- 32.6% of patients presented with ocular manifestations before the primary renal diagnosis.
- The uveal tract (choroid, iris, ciliary body) was the most frequently involved ocular structure.
- Treatment involved enucleation, surgery, radiotherapy, chemotherapy, and/or immunotherapy.
Conclusions:
- Ocular metastasis from renal malignancies, predominantly RCC, requires careful consideration in the differential diagnosis of intraocular masses.
- Early recognition of ophthalmic manifestations can be crucial for timely diagnosis and management of renal cancer.
- Multimodal treatment approaches are employed for ocular metastases from renal tumors.
