Rare metastasis to the iris from renal cell carcinoma responds to an anti-angiogenic therapy – a case report

A 73-year-old Afro-Caribbean man with pulmonary metastatic renal cell carcinoma presented to the ophthalmological department for decreased visual acuity, blurry vision and photophobia. Initial ocular examination revealed a 5 mm mass located to the iris. Cerebral magnetic resonance imaging (MRI) revealed a contrast enhancing lesion in the cerebellum measuring 5 mm, without surrounding edema. The iris mass was excised during cataract surgery. Histological examination of the mass revealed a clear cell proliferation and immunohistochemical analyses revealed a typical phenotype of clear cell renal cell carcinoma with expression of vimentin, CD10 and p504s. The final diagnosis was a metastatic clear cell renal cell carcinoma. A systemic treatment with sunitinib, a tyrosine kinase inhibitor of vascular endothelial growth factor receptor (VEGF) receptor pathway, was introduced with a good safety profile and six months follow up revealed no ophthalmic recurrence and stabilization of the pulmonary and cerebellum metastasis.