Ocular adnexal metastases from renal cell carcinoma: An update and comprehensive literature review

Tejal Magan; Tejus Pradeep; Madalina Tuluc; Jurij R Bilyk; Tatyana Milman

doi:10.4103/SJOPT.SJOPT_96_21

Ocular adnexal metastases from renal cell carcinoma: An update and comprehensive literature review

Saudi J Ophthalmol. 2022 Apr 18;35(3):209-216. doi: 10.4103/SJOPT.SJOPT_96_21. eCollection 2021 Jul-Sep.

Authors

Tejal Magan¹, Tejus Pradeep¹, Madalina Tuluc², Jurij R Bilyk³, Tatyana Milman^{1

2}

Affiliations

¹ Department of Pathology, Wills Eye Hospital, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, USA.
² Department of Pathology, Anatomy, and Cell Biology, Jefferson University Hospital, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, USA.
³ Oculoplastic and Orbital Surgery Service, Wills Eye Hospital, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, USA.

Abstract

Purpose: The purpose of this study was to review the clinical presentation, systemic work-up, and outcomes of all previously reported ocular adnexal (OA) metastases from renal cell carcinoma (RCC).

Methods: This was a literature review. PubMed and Google Scholar databases were searched for all well-documented cases of OA metastases from RCC.

Results: Final analysis identified 44 patients with either biopsy-confirmed (41/44, 93%) or treatment response-documented (3/44, 6%) OA metastases from RCC. Thirty-four (77%) patients were male. The median age was 60 years (mean: 60, range: 22-87 years). The most common presenting signs were proptosis (19/44, 43%) and OA mass (14/44, 32%). Metastases most frequently involved the orbital bones (10/44, 23%) and adjacent extraconal fat, extending from the sinonasal tract in 7/10 (70%) of these cases. OA metastases were initial manifestation of RCC in 18/44 (41%) patients. At the time of primary tumor diagnosis, 22 of 30 (73%) patients had American Joint Committee on Cancer Stage IV disease with metastases to 2 or more sites in 13 (57%) patients. Seventeen of 42 (40%) patients underwent local therapy only, which most commonly included excision/exenteration with margin control (10/17, 59%). Twenty-five of 42 (60%) patients had systemic therapy, which included biologic agents and chemotherapy. The absolute 5-year survival rate was 66% with significantly improved survival in patients reported after 2006 (92% vs. 42%, P = 0.04) and in those with isolated OA metastases (100% vs. 27%, P = 0.02) at 30 months.

Conclusion: Although RCC metastases to OA occur in a setting of advanced disease, the recent advances in diagnostic modalities and targeted therapies resulted in improved survival.

Keywords: Ocular adnexal metastases; ocular renal cell carcinoma; renal cell carcinoma eye; renal cell carcinoma ocular adnexal; renal cell carcinoma orbit.