metastasis of transitional cell carcinoma ( tcc ) of the renal pelvis to the eye is a very rare event and has only been reported in one case in the literature .
once diagnosed , these cases usually show widespread metastases and carry a very poor prognosis .
we present a case report of a male patient with unilateral choroidal metastasis secondary to tcc of the renal pelvis .
review of the relevant literature will be addressed to highlight the involvement of the choroid in cases of metastatic disease , the unusual presentation of tcc , diagnostic methods , and the various therapeutic modalities used to treat these cases .
a 61-year - old male , who has a history of congestive heart failure , is a nonsmoker , and has no significant family history of malignancies , presented to the ophthalmology clinic with sudden - onset loss of vision of the left eye associated with intermittent left eye pain , relieved by analgesics
. ophthalmic evaluation revealed a visual acuity of 20/40 in the right eye and 20/400 in the left eye .
funduscopic examination of the left eye showed an amelanotic macular choroidal lesion associated with inferior exudative retinal detachment ( fig 1a ) .
a b - scan ocular ultrasound showed a dome - shaped , 2.8-mm choroid thickening with variable internal reflectivity , associated with inferior exudative retinal detachment ( fig 1b ) .
fluorescein fundus angiography revealed early choroid blockage ( fig 1c ) and late leakage associated with hot spots at tumor margin .
all of these clinical features are suggestive of the clinical diagnosis of left choroidal metastasis .
physical examination of the patient also revealed multiple suspicious chest wall nodules . in search for a primary malignancy ,
imaging studies were done , which revealed multiple pulmonary and liver metastasis , subcutaneous metastasis , multiple lymphadenopathies , and left renal upper pole mass ( fig 2 ) .
ct - guided left renal mass biopsy and ultrasound - guided biopsy of the left chest wall subcutaneous mass were performed .
they are negative for ck20 , pax2 , ttf-1 , synaphopysin , and s100 ( fig 3 ) .
external beam radiation therapy ( ebrt ) is a common mode of treatment   and will be considered if there is no improvement of visual symptoms with chemotherapy .
choroidal metastasis is the most common intraocular malignancy , due to its rich vascular supply and high oxygen concentration [ 4 , 5 ] .
less common primary cancers include the thyroid , prostate , kidney , testicles , pancreas , ovary , and liver .
rarely is it seen in cases of tcc , as there have only been 5 previous reports in the literature involving choroidal metastasis , 3 from tumors involving the bladder , and 2 from other parts of the urinary tract .
choroidal metastasis is commonly associated with disseminated disease and , unfortunately , carries a very poor prognosis .
tcc usually metastasizes to the regional lymph nodes ( 78% ) , liver ( 38% ) , lung ( 36% ) , bone ( 27% ) , adrenal gland ( 21% ) , and intestine ( 13% ) .
the heart , brain , kidney , spleen , pancreas , meninges , uterus , ovaries , prostate , and testes have been reported as unusual sites of presentation of tcc .
other less common clinical presentations include flashes ( 5% ) and floaters ( 5% ) .
diagnosis is based on clinical findings , which are typically seen as yellow , plateau - shaped lesions associated with subretinal detachment .
a - scan and b - scan ultrasonography show irregular internal reflectivity and a solid plateau - shaped mass , respectively .
fluorescein fundus angiography typically shows mottled hypofluorescence in early stage and leakage in late stage .
the treatment of choroidal metastasis should be individually tailored , taking into consideration the patient 's systemic state , disease activity , and the presence of visual symptoms .
its aim is palliation , to improve the quality of life of the patient and to restore or maintain visual function .
local therapeutic regimens include ebrt , plaque radiotherapy , and complete enucleation for painful , blind eyes [ 13 , 14 ] .
ebrt delivered at a dose of 40 gy over 20 fractions was effective in improving and maintaining vision in patients with choroidal metastasis [ 15 , 16 ] . in cases of widespread metastases , systemic chemotherapy alone or in combination with local therapy is an accepted therapeutic option . in patients with choroidal metastasis alone ,
local therapy has been reported to be safe , maintaining visual functions without the systemic side effects of chemotherapy .
choroidal metastasis related to tcc of the renal pelvis is an extremely rare event and is associated with widespread disease and a very poor prognosis
. systemic chemotherapy with carboplatin and gemcitabine is a palliative treatment option for this patient .
ebrt offers local palliation and will be considered according to the patient 's visual response to chemotherapy .
 metastases of transitional cell carcinoma ( tcc ) of the renal pelvis to the eye is a very rare event , as only one previous case has been described in the literature . 
 we present a patient with choroidal metastasis secondary to tcc of the renal pelvis , with a review of the relevant literature . a 61-year - old male presented with sudden - onset loss of vision of the left eye . upon evaluation and assessment , 
 the patient was found to have unilateral choroidal metastasis secondary to tcc of the renal pelvis . 
 he is currently on palliative chemotherapy with carboplatin and gemcitabine . 
 external beam radiation therapy is a common mode of treatment and will be considered accordingly . 
Introduction
Case Report
Discussion
Conclusion
Statement of Ethics
Disclosure Statement