Gastric metastasis from renal cancer six years after nephrectomy

Abstract

Renal cell carcinoma is the third most common urogenital neoplasia (1). The lung and bone tissues represent the most frequent metastatic sites of renal cell carcinoma (2). Metastases in the stomach are rare and have been essentially described during autopsies (3). In this paper, we present a case of large metastatic gastric tumor whose origin was a renal cell carcinoma treated years ago. Case reportA 56 year old woman was diagnosed with stage one renal adenocarcinoma 6 years ago. She was treated with right radical nephrectomy and adjuvant chemotherapy. Three years later was diagnosed and treated of brain metastasis located in the frontal lobe, as well as in lung. A year ago, she came to our hospital for upper gastrointestinal bleeding. She presented acceptable general condition and nutritional, blood pressure 120/70 mmHg and normal cardio-respiratory auscultation. The abdomen was soft, non-tender, and no masses or organ enlargements. The analytical study revealed 6.3 g/dl hemoglobin. A thoracic abdominal TAC showed a large mass in the body and antrum stomach of 11 cm diameter without invasion adjacent structures. An upper gastrointestinal endoscopy revealed a large neoplasm from body to gastric antrum with mamelonated aspect. The patient underwent subtotal gastrectomy. The postoperative course was uneventful. The pathology and immunohistochemical study showed metastasis of kidney carcinoma ( Fig. 1). DiscussionMetastatic gastric cancer is uncommon. The most frequent location sites of cancer cells are in the body and gastric fundus, and single tumors predominate against multiple. Although generally gastric metastases account for 0.2-0.7% of stomach tumors, the metastatic tumor from carcinoma renal cells is extremely rare (3) and is an event late. The gastric metastases from renal cell carcinoma are diagnosed years after the primary tumor (4). The histological diagnoses require immunohistochemical analysis for differential diagnostic. We studied AE1/AE3 and vimentin markers, and the most recent CD10 and renal cell carcinoma markers (RCC-Ma). CD10 is a cell surface enzyme expressed in several types of normal cells including the brush border of renal tubular epithelial cells. Positivity for this marker is seen in more than 90% of renal clear carcinomas (5). RCC-Ma is a monoclonal antibody against a normal renal proximal tubule antigen. RCCMa expression is relatively specific for primary clear cell in renal carcinoma (6). In our case, the markers confirmed the diagnosis of renal carcinoma. The classic vimentin and AE1/AE3 markers were strongly positive, while CD10 and RCC-Ma showed moderately and weakly positive staining, respectively. The treatment of gastric metastases is controversial. The patients have poor prognosis with frequent extragastric metastases, and the treatment is endoscopic therapy and arterial embolization (7,8). The absence of evidence for other metastases and the presence of large tumor did not support the consideration of therapeutic endoscopy. By contrast, subtotal gastrectomy allowed acceptable...

Upper gastrointestinal bleeding secondary to late gastric metastasis of renal cell carcinoma

“…He had a personal history of left radical nephrectomy for clear cell renal cell carcinoma (G3, Primary neoplasms most commonly metastasizing to the stomach include breast cancer, lung cancer, and melanoma (1), with renal cell carcinoma being certainly rare (2), involving highly variable presentations that range from early to extremely late onsets (3). Today's higher rate of digestive endoscopy procedures and routine studies has increased the diagnosis of this condition (4,5); however, histology and immunohistochemistry studies with specific markers (positive CK AE1/AE3, CD10, PAX8, vimentin, and renal cell carcinoma antigens in our case) are key for a definitive diagnosis of metastatic gastric lesions, as pointed out by Adolfo Cruz et al (5). The lesion's atypical gross appearance for a primary gastric carcinoma and the patient's positive cancer history, even with such a delayed onset, should prompt consideration of this potential condition in the differential diagnosis.…”

Gastric metastasis of renal cell carcinoma 20 years after radical nephrectomy

“…Apart from these endoscopic resection/excision, systemic chemotherapy are used for the treatment of gastric metastases. [2,12] Our patient declined these treatments, and he is still under our control. In a recently published article achievement of complete remission was reported during 24 months of follow-up after radiotherapy, and pazopanib treatment.…”

“…[5] In the English literature, in 50 cases with renal cell carcinomas, gastric metastases were reported. [1][2][3][4][5][6][7][8][9][10][11][12] Median age of the cases was 66.5 (38-87) years. As is seen in our case, it is more frequently detected in men.…”

“…[1] It is the third most frequently seen neoplasia of the urogenital system. [2] Twenty -five percent of the cases are at advanced stage, and metastasize. [3] Renal cell carcinoma can spread through lymphatic, hematogenous, transcoelomic routes or through direct invasion.…”

“…[1,3] Up to now we could detect only a total of 50 cases in the literature. [1][2][3][4][5][6][7][8][9][10][11][12] In only 4 of these cases gastric metastases developed 20 or more years after diagnosis of renal cell carcinoma. [5,8,12] In this article we presented the 5 th case with gastric metastasis of renal cell carcinoma 20 years after he had undergone radical nephrectomy because of renal cell carcinoma.…”