Confronting Orbital Metastasis of Renal Cell Carcinoma – Retrospective Case Series

We reported three rare cases of metastatic renal cell carcinoma (RCC) with ocular and orbital symptoms as the first presentation. The first two cases depicted both elderly patients with a similar presentation of unilateral painless eye protrusion, blurring of vision and temporal scalp swelling. Examination revealed non-axial proptosis, temporal scalp firm pulsating mass and optic nerve dysfunction. Brain and orbit imaging revealed an extra-axial sphenoid wing tumour with infiltration to the temporalis muscle. Tumour excision was performed in one of the patients with histopathological examination showing RCC of clear cell variant. Subsequent computed tomography of thorax, abdomen and pelvis (CT TAP) revealed RCC with metastasis. The third case was RCC masquerading as a painful blind eye in a 65-year-old gentleman who was initially treated as absolute glaucoma and subjected to evisceration. Intraoperatively an adherent fibrotic mass on the inner surface of the scleral shell was later confirmed by histopathological exam as metastatic RCC. None of the patients has systemic signs and symptoms of RCC. Shared characteristics among these cases, potential risk factors, clinical progression, therapeutic interventions, outcomes, and challenges encountered in accurately diagnosing this uncommon disease were also discussed in this article.