起源于肾细胞癌(RCC)的脉络膜转移很少见。据我们所知,截至2024年1月31日,英文文献中已报道了31例RCC脉络膜转移。然而,医生需要警惕地认识到这种情况,因为其进展会影响受影响患者的生活质量(QOL)。在病例1中,一名具有乳头状RCC病史的60岁男性视力(VA)下降,并被诊断为孤立性脉络膜转移。随后,确定了多个转移,促使开始由pembrolizumab+axitinib组成的联合治疗方案.尽管治疗,观察到脉络膜转移的进展和VA的进一步下降。患者接受了立体定向放疗,脉络膜转移完全消退,伴随着VA的轻微改善。在病例2中,一名76岁的男子出现肾肿瘤并伴有肺转移。他接受了肾切除术,组织学诊断为乳头状RCC。我们启动了由纳武单抗联合卡博替尼组成的联合治疗。患者在治疗期间经历了VA的减少。我们发现广泛的细小转移散布在双侧脉络膜中。我们服用了阿西替尼,但患者经历了双侧失明。鉴于脉络膜转移没有既定的治疗方法,在治疗选择中保持灵活性至关重要。应在认为适合每个个案的情况下使用本地或系统方法。
Choroidal metastasis originating from renal cell carcinomas (RCCs) is rare. To the best of our knowledge, 31 cases of choroidal metastasis from RCC have been reported in the English literature as of January 31, 2024. Nevertheless, physicians need to be vigilant in recognizing this condition, as its progression impacts the quality of life (QOL) of affected patients. In
Case 1, a 60-year-old male with a medical history of papillary RCC experienced a deterioration in visual acuity (VA) and was diagnosed with solitary choroidal metastasis. Subsequently, multiple metastases were identified, prompting the initiation of a combination therapy regimen consisting of pembrolizumab plus axitinib. Despite treatment, progression of choroidal metastasis and a further decline in VA were observed. The patient underwent stereotactic radiotherapy and experienced complete resolution of the choroidal metastasis, accompanied by a slight improvement in VA. In
Case 2, a 76-year-old man presented with a renal tumor accompanied by lung metastases. He underwent nephrectomy, and the histological diagnosis was papillary RCC. We initiated combination therapy consisting of nivolumab plus cabozantinib. The patient experienced a decrease in VA during treatment. We identified extensive fine metastases scattered throughout the bilateral choroid. We administered axitinib, but the patient experienced bilateral blindness. Given the absence of established therapy for choroidal metastasis, it is crucial to maintain flexibility in treatment selection. Local or systemic approaches should be used as deemed appropriate for each individual
case.