Der Ophthalmologe : Zeitschrift der Deutschen Ophthalmologischen Gesellschaft · 2019
[Periocular metastasis as differential diagnosis of pyogenic granuloma and therapeutic marker of a systemic disease].
Клинический случайСтатьяНазвание и аннотация: Перевод в очереди
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Heichel Jens, Siebolts Udo, Wickenhauser Claudia, Viestenz Arne
Аннотация
BACKGROUND: A pyogenic granuloma is a frequent palpebral pseudotumor. Showing a typical clinical picture after an inflammation (hordeolum, chalazion) it can be easily diagnosed and sometimes a histopathological analysis is thought to be unnecessary.
METHODS: A case report of a patient suffering from a palpebral metastasis of a clear cell renal cell carcinoma (cRCC) as an atypical differential diagnosis of an inflammatory pseudotumor of the eyelid is presented.
RESULTS: A 72-year-old man presented for surgical treatment of a pyogenic granuloma. The medial portion of the inferior eyelid showed a nodular and pediculate lesion of the tarsal conjunctiva. At the time of presentation the patient was receiving adjuvant systemic treatment with cabozantinib because of lymphonodal and pulmonal metastases of the cRCC. The tumor was resected and the histopathological examination revealed a sarcomatoid dedifferentiated metastasis of the cRCC. After 4 weeks the tumor showed a local recurrence and histologically a local relapse was found. Therefore, a change in the systemic therapy was initiated (nivolumab). In the follow-up of 18 months no recurrence of the palpebral tumor occurred. A stable disease condition of the cRCC was achieved.
CONCLUSION: Even if the clinical aspect of an inflammatory tumor of the lids seems to be clear, a histopathological examination is still necessary. An interdisciplinary approach with reevaluation of the systemic therapy led to an improvement of the patient treatment.
METHODS: A case report of a patient suffering from a palpebral metastasis of a clear cell renal cell carcinoma (cRCC) as an atypical differential diagnosis of an inflammatory pseudotumor of the eyelid is presented.
RESULTS: A 72-year-old man presented for surgical treatment of a pyogenic granuloma. The medial portion of the inferior eyelid showed a nodular and pediculate lesion of the tarsal conjunctiva. At the time of presentation the patient was receiving adjuvant systemic treatment with cabozantinib because of lymphonodal and pulmonal metastases of the cRCC. The tumor was resected and the histopathological examination revealed a sarcomatoid dedifferentiated metastasis of the cRCC. After 4 weeks the tumor showed a local recurrence and histologically a local relapse was found. Therefore, a change in the systemic therapy was initiated (nivolumab). In the follow-up of 18 months no recurrence of the palpebral tumor occurred. A stable disease condition of the cRCC was achieved.
CONCLUSION: Even if the clinical aspect of an inflammatory tumor of the lids seems to be clear, a histopathological examination is still necessary. An interdisciplinary approach with reevaluation of the systemic therapy led to an improvement of the patient treatment.