Unilateral Blepharoptosis from Renal Cell Carcinoma

Main Article Content

Federico Greco
Lorenzo Sabatino
Francesco Sabatino
Manuele Casale
Carlo Cosimo Quattrocchi
Bruno Beomonte Zobel

Keywords

blepharoptosis, kidney cancer, orbital MRI, ptosis, renal cell carcinoma

Abstract

Blepharoptosis is the drooping or inferior displacement of the upper eyelid. Blepharoptosis can be either congenital or acquired. Tumour metastasis is one of the acquired causes of blepharop-tosis. The lungs, locoregional lymph nodes, bone and liver are the usual sites of metastases of renal cell carcinoma (RCC); however, unusual locations of RCC have also been reported. Herein, we describe a case of a 47-year-old man with unilateral ptosis and blurred vision due to meta-static RCC. We describe the different causes of blepharopstosis, the path that led to the diagno-sis, and how RCC can metastasize to unusual anatomical regions such as the orbit. Symptoms such as exophthalmos, lid edema, diplopia, ptosis, cranial nerve paralysis or blurred vision may mime a benign disease; however, they could also be the symptoms of a systemic malignancy.

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References

1. Finsterer J. Ptosis: causes, presentation, and management. Aesthet Plast Surg. 2003;27(3):193–204. http://dx.doi.org/10.1007/s00266-003-0127-5.
2. Baroody M, Holds JB, Vick L. Advances in the diagnosis and treatment of ptosis. Curr Opin Ophthalmol. 2005;16(6):351–355.
3. Edmonson BC, Wulc AE. Ptosis evaluation and management. Otolaryngol Clin N Am. 2005;38(5):921–46. http://dx.doi.org/10.1016/j.otc.2005.08.012.
4. SooHoo JR, Davies BW, Allard FD, Durairaj VD. Congenital ptosis. Surv Ophthalmol. 2014;59(5):483–92. http://dx.doi.org/10.1016/j.survophthal.2014.01.005.
5. Yadegari S. Approach to a patient with blepharoptosis. Neurol Sci. 2016;37(10):1589–96.
6. Evgeniou E, Menon KR, Jones GL, Whittet H, Williams W. Renal cell carcinoma metastasis to the paranasal sinuses and orbit. BMJ Case Rep. 2012. http://dx.doi.org/10.1136/bcr.01.2012.5492.
7. Mehelas TJ, Kosmorsky GS. Painful ophthalmoplegia syndrome secondary to metastatic renal cell carcinoma. J Neuroophthalmol. 1996;16(4):289–90.
8. Rai R, Jakobiec FA, Fay A. Ocular metastatic renal carcinoma presenting with proptosis. Ophtal Plast Reconstr Surg. 2015;31(4):e100–8. http://dx.doi.org/10.1097/IOP.0000000000000119.
9. Airoldi M, Succo G, Valente G, Cavalot A, Gabriele P, Bumma C. Head and neck metastases of renal cancer after nephrectomy: a report of 2 cases. Tumori 1995;81(3):213–4.
10. Matsumoto Y, Yanagihara N. Renal clear cell carcinoma metastatic to the nose and paranasal sinuses. Laryngoscope 1982;92:1190–3.
11. Kurli M, Finger PT. The kidney, cancer, and the eye: current concepts. Surv Ophthalmol. 2005;50(6):507–18. http://dx.doi.org/10.1016/j.survophthal.2005.08.003.
12. Civit T, Colnat-Coulbois S, Freppel S. Orbital metastasis. Neurochirurgie. 2010;56(2–3):148–51. http://dx.doi.org/10.1016/j.neuchi.2010.02.008.
13. Shields JA, Shields CL, Brotman HK, Carvalho C, Perez N, Eagle RC Jr. Cancer metastatic to the orbit: the 2000 Robert M. Curts Lecture. Ophthal Plast Reconstr Surg 2001;17(5):346–54.
14. Magliozzi P, Strianese D, Bonavolontà P, Ferrara M, Ruggiero P, Carandente R, et al. Orbital metastases in Italy. Int J Ophthalmol. 2015;8(5):1018–23. http://dx.doi.org/10.3980/j.issn.2222-3959.2015.05.30.
15. Yan J, Gao S. Metastatic orbital tumors in southern China during an 18-year period. Graefes Arch Clin Exp Ophthalmol. 2011;249(9):1387–93. http://dx.doi.org/10.1007/s00417-011-1660-6.
16. Amemiya T, Hayashida H, Dake Y. Metastatic orbital tumors in Japan: a review of the literature. Ophthalmic Epidemiol. 2002;9(1):35–47.
17. Albert DM, Rubenstein RA, Scheie HG. Tumor metastasis to the eye. I. Incidence in 213 adult patients with generalized malignancy. Am J Ophthalmol. 1967;63(4):723–726.
18. Shahabuddin S, Arnold F, Costello CB, Kumar S. Tumour angiogenesis factor in urological cancers. Br J Urol. 1984;56(5):490–4.
19. Thoenes W, Störkel S, Rumpelt HJ. Histopathology and classification of renal cell tumors (adenomas, oncocytomas and carcinomas). The basic cytological and histopathological elements and their use for diagnostics. Pathol Res Pract. 1986;181:125–143. http://dx.doi.org/10.1016/S0344-0338(86)80001-2.
20. Atta HR. Presumed metastatic transitional cell carcinoma of the choroids. Br J Ophthalmol. 1983; 67(12):830–3.
21. Gordon HL, Munro R. Ocular metastasis of bladder cancer. South Med J 1974; 67(6):745–6.
22. Tawil A, Cox JN, Roth AD, Briner J, Droz JP, Remadi S. Wilms’ tumor in the adult–report of a case and review of the literature. Pathol Res Pract. 1999;195(2):105–11; discussion 113. http://dx.doi.org/10.1016/S0344-0338(99)80081-8.
23. Finger PT, Warren FA, Gelman YP, McCormick SA. Adult wilms’ tumor metastatic to the choroid of the eye. Ophthalmology. 2002;109(11):2134–6.
24. Shome D, Honavar SG, Gupta P, Vemuganti GK, Reddy PV. Metastasis to the eye and orbit from renal cell carcinoma–a report of three cases and review of literature. Surv Ophthalmol. 2007;52(2):213–23. http://dx.doi.org/10.1016/j.survophthal.2006.12.004.