A Case of Diagnosed Renal Cell Carcinoma with Orbital Metastasis Presenting with Proptosis

ABSTRACT

PURPOSE: To report a very rare case of lacrimal gland metastasis of renal cell carcinoma presenting with proptosis. CASE SUMMARY: A 68-year-old man visited our clinic with a 3-month history of proptosis in the right eye. Corrected visual acuity was 0.8 in the right eye and 0.9 in the left eye and 11 mm proptosis of the right eye was observed. There were no specific findings except cataracts in both eyes. Orbital computed tomography (CT) demonstrated a solid lacrimal gland mass which was 24 x 36 x 29 mm in size and showed irregular enhancement. The CT scan also showed bone destruction around the orbital lateral wall and infiltration to the lateral rectus muscle. A metastatic tumor was suspected, thus a chest CT and abdominal CT were performed. The CT scan showed a large exophytic hypervascular mass with heterogeneous enhancement. The mass size was confirmed by the abdominal CT and malignant tumors were suspected. Regarding the left renal mass, a urology surgeon performed nephrectomy and adrenalectomy and regarding the lacrimal gland mass we performed an incisional biopsy via lid crease incision. Both masses were diagnosed as renal cell carcinoma based on the pathophysiologic findings. CONCLUSIONS: Lacrimal gland metastasis of renal cell carcinoma is very rare and extensive systemic evaluation for metastatic malignancy should be performed. In the present study, the authors report of a primary tumor found by chest CT a review of the literature.