Gastric metastasis presenting as submucosa tumors from renal cell carcinoma: A case report

Abstract

BACKGROUND Gastric metastasis from renal cell carcinoma (RCC) is an extremely rare clinical entity. Due to an easily neglected RCC history, nonspecific symptoms and under-recognized endoscopic presentation may lead to a potential diagnostic pitfall in daily clinical practice. CASE SUMMARY We present a case of metastatic gastric tumors arising from RCC 5 years after radical nephrectomy. Simultaneous, multifocal metastases to the gallbladder, pancreas and soft tissue were observed. One year previously, a solitary submucosal discoid tumor with a central depression was detected in the gastric fundus in a 65-year-old man. Endoscopic ultrasonography (EUS) showed a 1.12 x 0.38 cm lesion originating from the deeper mucosal layers with partially discontinuous submucosa. One year later, the endoscopic findings of the lesion showed various changes. A large lesion of the protruding type (2.5 cm × 2 cm) was found in the fundus at the same location. EUS showed a heterogeneous mass that involved the mucosa and submucosal layer. In addition, two small similar submucosal lesions 0.4-0.6 cm in size were detected. These lesions had a central depression, surface mucosal congestion and thickened vessels. The two adjacent lesions in the fundus were resected by endoscopic submucosal dissection. Based on the postoperative pathological analysis, the patient was diagnosed with gastric metastasis from RCC. CONCLUSION Gastric metastasis from RCC should be considered in patients with a history of RCC irrespective of the time interval involved.

Case report: Uncommon gastric metastasis as a presentation of recurrent clear cell renal cell carcinoma

“…The median time between the onset of RCC and metachronous gastric metastasis was reported to be 8.5 years for solitary metastasis and 5 years for multiple metastasis which extended to 9 years in our particular case ( 25 ). The potential mechanisms underlying the gastrointestinal involvement of RCC include direct tumor invasion or dissemination through lymphatic, transcelomic, or hematogenous routes ( 28 ). Prognostic and risk markers for gastrointestinal metastasis arising from RCC encompass a spectrum of factors.…”

“…It includes patient-specific considerations such as a patient’s medical history, especially instances where RCC may have gone undiagnosed, the presence of non-specific symptoms, time since diagnosis, overall health, and poor prognosis during endoscopy. Additionally, tumor genetics, tumor stage, and histological subtype are significant contributors; ccRCC with Von-Hippel VHL gene mutations, Papillary RCC with Type I: MET protooncogene, Type II: SETD2, CKDN2A, and TFE3, and Chromophobe RCC with TERT promoter gene mutations ( 18 , 28 – 30 ). These markers are instrumental in assessing the likelihood of metastasis, guiding treatment decisions, and evaluating prognosis.…”

“…Up until 2017, only 37 documented cases of gastric metastasis post RCC were reported, underscoring the rarity of this condition. Out of these 37 cases reported, surgical resection remaind the most commonly performed treatment ( 28 ). However, the impact of surgically removing the metastatic gastric tumor on overall survival remains uncertain.…”

Metastatic Renal Cell Carcinoma to Pancreas: Case Series and Review of the Literature

“…Moreover, as reported in one of our cases, digestive involvement of RCC metastasis includes gastrointestinal tract (stomach, duodenum, colon), ampulla of Vater and gallbladder in addition to the pancreas. Metastases can occur simultaneously in GI sites, as in our case, or at different timepoints during follow-up [ 20 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 ].…”

Discovery of Gastric Metastases From Primary Renal Cell Carcinoma Through MRI: A Case Report

“…Moreover, it is an efficient and rapid solution if the metastasis causes acute bleeding [ 8 ]. If multiple, complete resection of metastases also increases patient survival [ 12 , 13 ].…”