ABSTRACT
PURPOSE: 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. METHODS: Case report. RESULTS: 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. CONCLUSION: 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.
Subject(s)
Carcinoma, Renal Cell , Eye Diseases , Kidney Neoplasms , Retinal Detachment , Female , Humans , Adult , Retinal Detachment/surgery , Carcinoma, Renal Cell/drug therapy , Kidney Neoplasms/complications , Eye Diseases/surgery , Vitreous Body/pathology , Vitrectomy/adverse effectsSubject(s)
Adenocarcinoma/secondary , Brain Neoplasms/secondary , Esophageal Neoplasms/pathology , Adenocarcinoma/diagnosis , Adenocarcinoma/therapy , Aged , Biopsy , Brain Neoplasms/diagnosis , Brain Neoplasms/therapy , Combined Modality Therapy , Esophageal Neoplasms/therapy , Esophagectomy , Humans , Magnetic Resonance Imaging , Male , Neoplasm Recurrence, LocalABSTRACT
Primary hepatic leiomyosarcoma (LMS) is a rare malignancy of the liver in adults, with variable overall survival (OS). The main purpose of this study was to identify prognostic factors of improved survival. Relevant data were abstracted from MEDLINE, EMBASE, and Academic Search Premiere (ASP), and from the medical records of a patient treated at our institution. Multivariate analysis was conducted by generating Cox proportional hazard ratios. We identified 109 patients with primary hepatic LMS; 95 were included for basic description, and 84 for OS analysis. Median age was 58 years (range 19-86 years), 45.0% of the patients were female, and 21.1% were AJCC stage IV. The primary treatment for all 95 patients was as follows: 61.1% had surgery, 13.7% had chemotherapy, 5.3% had liver transplantation, 2.1% received radiotherapy, and 14.7% were managed conservatively. Median OS was 19 months (range 0-181 months) with 1-, 2-, and 5-year survival rates of 61.2, 41.1, and 14.5%, respectively. In a multivariate analysis, smaller size of the largest hepatic lesion (p = 0.038) and negative resection margin (p = 0.0004) were associated with improved survival. Complete surgical resection with clear margin is necessary to improve survival of patients with primary hepatic LMS.
