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A 38-year-old man presented to the ophthalmology department with a four-week history of defective central vision in his right eye. Examination of the fundus of the right eye showed two discrete, yellowish-orange subretinal masses, each measuring about 2.5 mm in diameter, occupying the posterior pole and involving the macular area (long arrows, Panel A). There was localized overlying edema of the neurosensory retina (short arrows, Panel A). The left fundus was unremarkable. The appearance of the fundus in the right eye was highly characteristic of choroidal metastasis.
Two months earlier, the patient had been admitted to the medical ward with a two-month history of low back pain. Plain-film radiographs of the spine were suggestive of bony metastasis. A computed tomographic (CT) scan of the abdomen and chest showed a large right-sided (R) suprarenal mass (arrow, Panel B) with evidence of mediastinal and hilar lymphadenopathy and intrapulmonary metastasis. Whole-body bone scans showed bony metastasis in the lumbar spine and the skull vault. A CT-guided renal biopsy was diagnostic of clear-cell renal carcinoma. The patient underwent palliative radiotherapy for his renal tumor and choroidal metastasis, but he died five months after his initial presentation.
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