380 Journal of the College of Physicians and Surgeons Pakistan 2008, Vol. 18 (6): 380-381 INTRODUCTION Metastatic carcinoma to the eye is more common than primary neoplasm. The most common malignancy that gives rise to metastatic carcinoma to the eye is breast cancer in females and lung cancer in males. Other less frequent sites include gastrointestinal tract, skin and kidneys. Choroidal metastasis of renal cell carcinoma is rare, typically tend to have a characteristic reddish orange color and can appear years after treating the primary. 1 This case report describes metastases from renal cell carcinoma that presented with cataract. CASE REPORT The patient was a 71 years old male presenting with 03 months history of gradually progressive painless deterioration of vision in the right eye. Past history revealed that he underwent left nephrectomy in 1999 because of renal mass. Visual acuity in right eye was 3/60 pre-operatively and fundus examination revealed a hazy view with healthy appearing posterior pole. He underwent cataract extraction in October 2007 and visual acuity improved to 6/12 unaided after 01 week. After 04 weeks, he presented again with deterioration of vision. On examination, visual acuity in right eye was perception of light and fundus view was hazy due to visible floating masses in vitreous. There was a mushroom shaped growth in inferotemporal fundus along with localized retinal detachment. Keeping in view the provisional diagnosis of primary / metastatic choroidal neoplasm, patient was investigated. Ultrasound B-scan (Figure 1) revealed a 9 x 7.7 mm spherical solid mass projecting into the vitreous from temporal side with medium internal reflectivity and no shadowing or calcification. It had broad base, which was in continuity with the choroid. The mass showed pathological vessels on Doppler ultrasound (Figure 2). Partial retinal detachment with shifting fluid was seen in sub-retinal space adjacent to the mass. Sheet like echoes were also seen in vitreous. No mass was seen in the retrobulbar area. Blood CP, serum LFTs, plasma glucose random, serum urea and serum creatinine were within normal limits. Abdominal ultrasound revealed right renal cyst with adrenal enlargement and absent left kidney. X-ray chest PA view did not reveal any abnormality. Keeping in view the progressive increase in the size of tumor and involvement of vitreous and visual status, he was counselled for enucleation. After 02 weeks, he consented for operation. Enucleation was done with extraocular muscles attached in the Allen implant (medial rectus stitched to the lateral and superior rectus stitched to inferior) and conformor placed in the conjunctival sac. During surgery, a dark coloured reddish brown mass was seen adjacent to globe, which was also excised and sent for histopathology. ABSTRACT We report a case of rare involvement of the eye with choroidal metastasis from renal cell carcinoma presenting 08 years after the primary tumor was removed. The patient initially presented with cataract most probably induced by the tumor. After cataract extraction, tumor was detected when it induced vitreous involvement and retinal detachment. Enucleation was performed and an extraocular mass was also excised. Histopathology confirmed the diagnosis of metastasis from renal cell carcinoma in the ocular tumor, extraocular mass and the vitreous. Key words: Choroidal metastasis. Renal cell carcinoma. Enucleation. Department of Eye, Combined Military Hospital, Kharian. Correspondence: Lt. Col. Khawaja Khalid Shoaib, Head of Eye Department, Combined Military Hospital, Kharian. E-mail: kkshoaib@hotmail.com Received January 3, 2008; accepted April 10, 2008. Choroidal Metastasis from Renal Cell Carcinoma Presenting with Cataract Khawaja Khalid Shoaib, Inam-ul-Haq, Kashif Ali, M. Ahsan Mukhtar, Muhammad Nazir Qureshi and Nadeem Zafar CASE REPORT Figure 1: Mushroom shaped growth in inferotemporal fundus along with retinal detachment. Figure 2: Doppler ultrasound showing moderate vascularity in the mass.