The first choroidal metastasis case was described by Perl in 1872 [2]. Godtfredsen, reported a 0.07% incidence of clinically detected choroidal metastasis in patients with systemic malignancy in 1944 [3]. Since then, the reported incidence of choroidal metastasis has been increasing related to advances in ophthalmic diagnostic techniques and the treatment of systemic cancers [4].
Although breast and lung cancers represent the most common source of choroidal metastases, malignancies of the gastrointestinal tract, kidney, prostate and skin have all been reported to metastasize to the choroid [5]. Most reported cases of metastasis to the choroid plexus from renal cell carcinoma describe a clear cell carcinoma histologic subtype. The mechanism of this association is still unclear. Choroidal metastasis from TPRCC, as in our case, remains very exceptional [6].
Clinically, the most common symptoms are blurring of vision, photopsia, floaters and pain whereas some patients may be asymptomatic. Typical ophtalmoscopic features include one or multiples creamy yellow choroidal lesions associated in some advanced cases with secondary retinal detachment [7].
In patients with metastatic cancer to the choroids, the most appropriate treatment seems to be a course of external beam radiation therapy. Radiotherapy can improve vision with a high response rate (63-89%) [8] and prevent pain and secondary glaucoma [9]. Systemic chemotherapy or hormonotherapy may be effective to controle choroidal metastasis with 26-81% tumor control rate reported [10, 11]. In cases of painful blind eye, enucleation may be considered [12].
The prognosis for choroidal metasatsis is generally poor. The median survival was found to be as short as 8 months after the onset of metastatic disease [13].
Choroidal metastasis from renal carcinoma is a rare condition that should not be overlooked. A high index of suspicion and adequate investigation of patients with visual complaints and history of renal carcinoma are needed.