Unusual Initial Presentation of Renal Cell Carcinoma: Orbital Metastasis

This case describes an unusual orbital metastasis revealing a clear cell renal carcinoma (ccRCC). It’s about a 67- year-old woman with a history of hypertension presented with left hemifacial headaches and progressive exophthalmos. Orbital CT scan and MRI showed a lesion of the left orbital roof with extradural and intra orbital extension. The patient underwent neurosurgical resection of the orbital mass. Histopathological examination revealed a metastatic clear cell carcinoma. Subsequent abdominal CT scan identified a 2 cm mass in the lower pole of the right kidney. A right radical nephrectomy was performed, confirming the diagnosis of primary RCC. Despite initial remission, the patient experienced an orbital recurrence. Due to dosimetric constraints, radiotherapy was not feasible. Targeted therapy with sunitinib was initiated. The patient has remained clinically stable for over 24 months under regular follow-up. This case highlights the diagnostic and therapeutic challenges of orbital metastasis revealing RCC. It underscores the importance of considering metastatic disease in atypical orbital presentations and supports the role of targeted therapy when local options are limited.