Metastatic Renal Cell Carcinoma to the Eye and Adnexae: A Report of Three Cases and Review of the Literature

Three cases of metastatic renal cell carcinoma to the ocular structures are presented. Each of these tumors clinically simulated a more common ocular entity, thus causing diagnostic difficulty. The first patient had a metastatic tumor to the eyelid that clinically simulated a large chalazion. The second patient had a choroidal tumor with clinical features and ancillary studies strongly suggestive of a primary choroidal melanoma. The third patient presented with unilateral proptosis secondary to an orbital mass that was clinically believed to be a cavernous hemangioma of the orbit. In each case, there was a long interval between the initial diagnosis (15 months, 9 years, and 15 years respectively), and the ocular metastasis, which represented the first sign of metastatic disease.     

Vision Loss from Choroidal and Pituitary Metastases Secondary to Renal Cell Carcinoma: A Case Report

A 62-year-old male with a history of metastatic clear cell renal cell carcinoma (ccRCC) presented with decreased vision to 20/50 in the left eye. Fundus examination revealed an elevated, amelanotic mass lesion in the superotemporal macula, without involvement of the central macula by subretinal fluid or tumour. Given incongruity between the fundus findings and the degree of visual impairment, visual field testing was obtained, revealing a bitemporal hemianopia. Magnetic resonance imaging demonstrated optic chiasm compression by a pituitary mass, which had previously been overlooked on computed tomography imaging. Biopsy confirmed metastatic ccRCC to the pituitary, which presented simultaneously with the presumed choroidal metastasis.     

Clinicopathological Analysis of Malignant Eyelid Tumor Cases at Yamagata University Hospital: Statistical Comparison of Tumor Incidence in Japan and in Other Countries

Purpose

To report the clinical and histopathological features of malignant eyelid tumor cases treated in our clinic. We also compared the differences in the frequency of malignant eyelid tumor in various regions of Japan and worldwide.

Methods

Retrospectively, we studied the records of the 38 cases of malignant eyelid tumor treated in Yamagata University Hospital over the last 17 years. The statistical comparison with various countries was based on reports of case studies in those countries.

Results

Data from our clinic: Among the total of 38 cases, 15 cases (39.5%) were diagnosed as basal cell carcinoma, 11 cases (28.9%) as sebaceous gland carcinoma, and 4 cases (10.5%) as squamous cell carcinoma. In addition, three cases were malignant melanoma, two adenocarcinoma, one Merkel cell carcinoma, one malignant peripheral nerve sheath tumor, and one malignant lymphoma. The ages of patients ranged from 45 to 92 years (mean, 72.0 ± 12.4 years). Most of the cases were treated by complete resection of the tumors and eyelid reconstruction. Radiation or cryotherapy were added when required. The prognosis of the cases with basal cell carcinoma and squamous cell carcinoma was good, and that of the other tumors was relatively poor. During the same period, in Caucasians, basal cell carcinoma constituted about 80%–90% of the malignant eyelid tumors, whereas in Japan and Asian countries, basal cell carcinoma, sebaceous gland carcinoma, and squamous cell carcinoma each constituted about 20%–40%.

Conclusions

A racial difference in the incidence of basal cell carcinoma, sebaceous gland carcinoma, and squamous cell carcinoma can be considered in making a diagnosis. Jpn J Ophthalmol 2005;49:349–354 © Japanese Ophthalmological Society 2005     

眼睑基底细胞癌中整合素αvβ3、Tmem16a 表达及其与血管内皮生长因子的相关性

探讨整合素αvβ3与跨膜蛋白16a（Tmem16a）在眼睑基底细胞癌中的表达及其与血管内皮生长因子（VEGF）的相关性。方法：实验研究。选择2013年5月至2017年5月郑州人民医院眼科72份确诊的眼睑基底细胞癌术后组织为研究组,另取经病理证实的癌旁正常组织40份作为对照组,运用免疫组化法测定其整合素αvβ3、Tmem16a、VEGF蛋白表达情况,分析整合素αvβ3、Tmem16a、VEGF 蛋白表达情况与患者临床特征的关系,探讨整合素αvβ3、Tmem16a蛋白与VEGF的相关性。采用t检验或χ2 检验进行组间比较,采用单因素Logistic回归分析αvβ3、Tmem16a及VEGF表达的影响因素,采用Pearson线性相关分析其相关性。结果：研究组整合素αvβ3、Tmem16a、VEGF阳性表达率均明显高于对照组（χ2 =16.94、24.38、23.94,P<0.05）。研究组整合素αvβ3、Tmem16a、VEGF阳性率的影响因素均包括增殖细胞核抗原增殖指数、肿瘤最大直径（P<0.05）,而与患者性别、年龄无相关性（P>0.05）。眼睑基底细胞癌患者的癌组织中整合素αvβ3、Tmem16a的表达与VEGF表达呈正相关（r=0.642、0.516,P<0.001）。结论：整合素αvβ3、Tmem16a在眼睑基底细胞癌中高表达,且与肿瘤最大直径、增殖细胞核抗原增殖指数相关,其可能通过促进VEGF表达促进血管新生,加快眼睑基底细胞癌的发生及进展。     

Micrographically controlled excision (Mohs' surgery) of basal cell carcinoma around the eye: Combined dermatological surgical clearance and oculoplastic surgical repair

Periorbital infiltrative basal cell carcinomas are notoriously difficult to treat, particularly those around the medial canthus. Micrographically controlled excision with horizontal frozen sections (Mohs' surgery) allows for clearance of the tumour with minimal loss of normal tissue. Once the tumour has been completely removed, the defect can be repaired by the oculoplastic surgeon for the best functional and cosmetic result. This is the ideal treatment for tumours with a contiguous growth pattern that are liable to be seriously over or under treated by other modalities.
The technique requires special training for both the operator and the Medical Laboratory Scientific Officer (MLSO). It is costly in time and manpower but in selected cases, where recurrent tumour is most dangerous and where tissue conservation is paramount, it may be invaluable. Close collaboration between dermatological and oculoplastic surgeons in such cases probably offers the patient the best treatment and outcome.     

The Collaborative Ocular Tuberculosis Study (COTS)-1 Report 3: Polymerase Chain Reaction in the Diagnosis and Management of Tubercular Uveitis: Global Trends

Purpose: To analyze the role of polymerase chain reaction (PCR) of ocular fluids in management of tubercular (TB) anterior, intermediate, posterior, and panuveitis.

Methods: In Collaborative Ocular Tuberculosis Study (COTS)-1 (25 centers, n = 962), patients with TB-related uveitis were included. 59 patients undergoing PCR of intraocular fluids (18 females; 53 Asian Indians) were included.

Results: 59 (6.13%) of COTS-1 underwent PCR analysis. PCR was positive for Mycobacterium TB in 33 patients (23 males; all Asian Indians). 26 patients were PCR negative (18 males). Eight patients with negative PCR had systemic TB. Anti-TB therapy was given in 18 negative and 31 PCR cases. At 1-year follow-up, five patients with positive PCR (15.15%) and three with negative PCR (11.54%) had persistence/worsening of inflammation.

Conclusions: Data from COTS-1 suggest that PCR is not commonly done for diagnosing intraocular TB and positive/negative results may not influence management or treatment outcomes in the real world scenario.