Images in Clinical Urology Eyelid Metastasis as the Initial Presentation of a Renal Cell Carcinoma ~aranda, and Francisco Gonzalez, Jose Manuel Abalo-Lojo, Jose M. Suarez-Pen mez Javier Caneiro-Go Renal cell carcinoma (RCC) often metastasizes to the lungs, liver, brain, and bones. Eyelid metastasis of a distant RCC is an infrequent condition. Breast carcinoma and lung malignancies are responsible of most eyelid metastases, although other malignancies may also metastasize to the eyelid. We report a case with eyelid metastasis as a first presentation of a distant RCC. UROLOGY 85: e35ee36, 2015. 2015 Elsevier Inc.
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77-year-old man presented with a small mass in the inferior left eyelid (Fig. 1A) with no systemic condition. Histopathology showed dermal infiltration by intermediate-size cells with clear cytoplasm and irregular nuclei and with scarce stroma and abundant vessels. Cytokeratin AE1/AE3, vimentin, CD10, epithelial membrane antigen, PAX-8, CA-IX, and renal cell carcinoma (RCC) marker were positive (Fig. 1C-F). Carcinoembryonic antigen, smooth muscle actin, S-100 protein and TFE3 were negative, suggesting a metastasis from a primary RCC. A computed tomography scan disclosed a right kidney mass (Fig. 1B) displacing the renal vein with no extracapsular extension and multiple nodules in the lungs. Eyelid metastases usually appear in patients with known cancer, with widespread systemic involvement and may have their origin in the kidney.1-5 Cutaneous lesions as the first presentation of RCC are extremely uncommon.6 We found 12 reported cases of RCC presenting as skin metastases but in no case involved only the eyelids. Our
patient was not aware of any relevant systemic disease, and the eyelid lesion was the first presentation of this malignancy. It was the histopathology study that disclosed the renal origin. At the moment of writing this article, the patient is being treated with pazopanib. References 1. Mansour AM, Hidayat AA. Metastatic eyelid disease. Ophthalmology. 1987;94:667-670. 2. Arnold AC, Bullock JD, Foos RY. Metastatic eyelid carcinoma. Ophthalmology. 1985;92:114-119. 3. Esmaeli B, Cleary KL, Ho L, et al. Leiomyosarcoma of the esophagus metastatic to the eyelid: a clinicopathologic report. Ophthal Plast Reconstr Surg. 2002;18:159-161. 4. Colombo F, Viestenz A, Holbach LM. Eyelid tumor as a recurrence of a gastric MALT-lymphoma. Klin Monatsbl Augenheilkd. 2000;217: 133-135. 5. Ahmad SM, Esmaeli B. Metastatic tumors of the orbit and ocular adnexa. Curr Opin Ophthalmol. 2007;18:405-413. 6. Porter NA, Anderson HL, Al-Dujaily S. Renal cell carcinoma presenting as a solitary cutaneous facial metastasis: case report and review of the literature. Int Semin Surg Oncol. 2006;3:27.
Financial Disclosure: The authors declare that they have no relevant financial interests. Funding Support: This work was supported by Red Teamatica de Investigacion Cooperativa en Salud RD12/0034/0017, Oftared, from the Instituto de Salud Carlos III, Ministerio de Economia y Hacienda, Spain. From the Service of Ophthalmology, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, Spain; the Department of Surgery, CIMUSIDIS, University of Santiago de Compostela, Santiago de Compostela, Spain; and the Department of Pathology, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, Spain Address correspondence to: Francisco Gonzalez, M.D., Ph.D., CIMUS-IDIS, Universidad de Santiago de Compostela, E-15782 Santiago de Compostela, Spain. E-mail: [email protected] Submitted: December 12, 2014, accepted (with revisions): January 29, 2015
ª 2015 Elsevier Inc. All Rights Reserved
http://dx.doi.org/10.1016/j.urology.2015.01.039 0090-4295/15
e35
Figure 1. Solitary ulcerated nodular tumor in the lower eyelid of the left eye observed at the patient’s presentation (A). Computed tomography scan showing a mass in the right kidney (arrow, B). Low-power image of the lesion showing a polypoid configuration; the tumor involved the dermis and displayed a solid pattern (C). Cells had wide, clear cell cytoplasm throughout the lesion with mild nuclear atypia (Fuhrman grade 2/4), and they were arranged in solid nests separated by a delicate capillary vascular network, with scant stroma interspersed (D). Immunohistochemistry was diffusely positive for cytokeratin AE1/AE3 (E) and CD10 (F), suggesting the renal origin of the neoplasm.
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UROLOGY 85 (5), 2015
A
77-year-old man presented with a small mass in the inferior left eyelid (Fig. 1A) with no systemic condition. Histopathology showed dermal infiltration by intermediate-size cells with clear cytoplasm and irregular nuclei and with scarce stroma and abundant vessels. Cytokeratin AE1/AE3, vimentin, CD10, epithelial membrane antigen, PAX-8, CA-IX, and renal cell carcinoma (RCC) marker were positive (Fig. 1C-F). Carcinoembryonic antigen, smooth muscle actin, S-100 protein and TFE3 were negative, suggesting a metastasis from a primary RCC. A computed tomography scan disclosed a right kidney mass (Fig. 1B) displacing the renal vein with no extracapsular extension and multiple nodules in the lungs. Eyelid metastases usually appear in patients with known cancer, with widespread systemic involvement and may have their origin in the kidney.1-5 Cutaneous lesions as the first presentation of RCC are extremely uncommon.6 We found 12 reported cases of RCC presenting as skin metastases but in no case involved only the eyelids. Our
patient was not aware of any relevant systemic disease, and the eyelid lesion was the first presentation of this malignancy. It was the histopathology study that disclosed the renal origin. At the moment of writing this article, the patient is being treated with pazopanib. References 1. Mansour AM, Hidayat AA. Metastatic eyelid disease. Ophthalmology. 1987;94:667-670. 2. Arnold AC, Bullock JD, Foos RY. Metastatic eyelid carcinoma. Ophthalmology. 1985;92:114-119. 3. Esmaeli B, Cleary KL, Ho L, et al. Leiomyosarcoma of the esophagus metastatic to the eyelid: a clinicopathologic report. Ophthal Plast Reconstr Surg. 2002;18:159-161. 4. Colombo F, Viestenz A, Holbach LM. Eyelid tumor as a recurrence of a gastric MALT-lymphoma. Klin Monatsbl Augenheilkd. 2000;217: 133-135. 5. Ahmad SM, Esmaeli B. Metastatic tumors of the orbit and ocular adnexa. Curr Opin Ophthalmol. 2007;18:405-413. 6. Porter NA, Anderson HL, Al-Dujaily S. Renal cell carcinoma presenting as a solitary cutaneous facial metastasis: case report and review of the literature. Int Semin Surg Oncol. 2006;3:27.
Financial Disclosure: The authors declare that they have no relevant financial interests. Funding Support: This work was supported by Red Teamatica de Investigacion Cooperativa en Salud RD12/0034/0017, Oftared, from the Instituto de Salud Carlos III, Ministerio de Economia y Hacienda, Spain. From the Service of Ophthalmology, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, Spain; the Department of Surgery, CIMUSIDIS, University of Santiago de Compostela, Santiago de Compostela, Spain; and the Department of Pathology, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, Spain Address correspondence to: Francisco Gonzalez, M.D., Ph.D., CIMUS-IDIS, Universidad de Santiago de Compostela, E-15782 Santiago de Compostela, Spain. E-mail: [email protected] Submitted: December 12, 2014, accepted (with revisions): January 29, 2015
ª 2015 Elsevier Inc. All Rights Reserved
http://dx.doi.org/10.1016/j.urology.2015.01.039 0090-4295/15
e35
Figure 1. Solitary ulcerated nodular tumor in the lower eyelid of the left eye observed at the patient’s presentation (A). Computed tomography scan showing a mass in the right kidney (arrow, B). Low-power image of the lesion showing a polypoid configuration; the tumor involved the dermis and displayed a solid pattern (C). Cells had wide, clear cell cytoplasm throughout the lesion with mild nuclear atypia (Fuhrman grade 2/4), and they were arranged in solid nests separated by a delicate capillary vascular network, with scant stroma interspersed (D). Immunohistochemistry was diffusely positive for cytokeratin AE1/AE3 (E) and CD10 (F), suggesting the renal origin of the neoplasm.
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UROLOGY 85 (5), 2015
