Late presentation of metastatic renal cell carcinoma as a bleeding ampullary mass

Robertson, Glen S.; Gertler, Stanford L.

doi:10.1016/s0016-5107(90)71032-2

Cited by 33 publications

(10 citation statements)

References 10 publications

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“…Metastatic tumors to the pancreas, excluding those involved with widespread disease or in direct continuity with the pancreas, are rare clinically and are exceedingly difficult to differentiate from a primary pancreatic neoplasm. When metastatic foci to the pancreas clinically manifest as mass lesions, lung, breast, colon, skin (melanoma), and kidney primary tumors are among the metastatic neoplasms that are found most frequently 1–58. Secondary involvement of the pancreas by metastatic renal cell carcinoma (RCC), especially in surgical pathology material, is rare.…”

mentioning

confidence: 99%

Renal cell carcinoma to the pancreas in surgical pathology material

Thompson

Heffess

2000

Cancer

175

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mentioning

confidence: 99%

Renal cell carcinoma to the pancreas in surgical pathology material

Thompson

Heffess

2000

Cancer

175

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“…Confusion with a primary pancreatic tumor is possible (2,3), otherwise gastrointestinal bleeding can reveal metastasis with duodenal wall or ampullary involvement (4,9); and (d) prognosis after pancreatic resection is good, since survival frequently exceeds 1 year and can reach up to 23 months, as in our first patient (3,4). Confusion with a primary pancreatic tumor is possible (2,3), otherwise gastrointestinal bleeding can reveal metastasis with duodenal wall or ampullary involvement (4,9); and (d) prognosis after pancreatic resection is good, since survival frequently exceeds 1 year and can reach up to 23 months, as in our first patient (3,4).…”

Section: Discussionmentioning

confidence: 84%

Choledochal Cyst with a Rare Type of Anomalous Pancreaticobiliary Ductal Union

et al. 1993

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colleagues on "Arterial complications of pancreatitis: Diagnostic and therapeutic role of radiology" in this issue of Pancreas (pp. 687-692). Savastano et al. describe the results of operative angiographic therapy of nine patients with arterial complications of pancreatitis. Six patients had pseudoaneurysms associated with pancreatitis, one had postoperative bleeding from the splenic artery, and two had pseudoaneurysms associated with the pancreaticoduodenal artery but none associated with pseudocyst. There was one death among the nine patients: the patient who experienced postoperative bleeding from the splenic artery.The authors rightly emphasize the important role angiography holds in the diagnosis of arterial complications of pancreatitis. However, they recommend limiting angiographic embolization therapy to patients having pseudoaneurysms of the pancreatic vasculature in the absence of pseudoc! st, except when the patient is actually bleeding, and then only for temporary control.This writer's own experience does not support this view. In Case 8, in which a pseudoaneurysm was associated with a pseudocyst, embolization provided definitive therapy for the pseudoaneurysm. While the associated pseudocyst required surgery, including a cystojejunostomy only two weeks after embolization of the pancreaticoduodenal artery, no bleeding occurred then or during a follow-up period of two years. Had the authors chosen to embolize Cases 1 , 2, 3 , 6 , and 7, they might have avoided two pancreaticoduodenectomies, at the least, and perhaps three distal pancreatectomies and splenectomies. In our experience, and that of others, embolization of the pseudoaneurysms has been definitive therapy for the pseudoaneurysm, whether the aneurysm is associated with a cyst or not. Once the pseudoaneurysm is angiographically controlled, the associated pseudocyst does not need to be resected but can be drained by cystogas-trostomy or cystojejunostomy . In some instances the pseudocyst may resolve spontaneously and not require operative therapy either. Resective pancreatic surgery is infrequently required for pancreatic control of bleeding from pseudoaneurysms when angiographic embolization is aggressively pursued, whether or not the pseudoaneurysm is associated with a pseudocyst.

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“…Metastasis of renal cell carcinoma and testicular neoplasms is a commonly reported cause for UGI bleeding secondary to urological malignancies in the literature [13, 14]. To our knowledge, UGI bleeding from duodenal metastasis of TCC originating from urinary bladder is rarely reported.…”

Section: Discussionmentioning

confidence: 99%

Massive Upper Gastrointestinal Bleeding Secondary to Duodenal Metastasis of Transitional Cell Carcinoma of the Urinary Bladder

Chan¹,

Al-Busafi

Waschke

2011

Case Rep Gastroenterol

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Acute upper gastrointestinal (UGI) bleeding is a common problem in our clinical practice and is often due to peptic ulcer diseases. Occasionally, malignancy may be implicated in these situations. Here we report a rare case of UGI bleeding secondary to metastatic transitional cell carcinoma (TCC) of the urinary bladder. A 62-year-old man with a history of stage IIIb TCC of the urinary bladder presented with hematemesis. Endoscopy showed a large tumor in the second stage of the duodenum that occupied 40% of the duodenal circumference, over 7 cm in length. Biopsies revealed a poorly differentiated malignant neoplasm consistent with metastasis from urothelial carcinoma that was identical to the previous surgical specimen of the urinary bladder. He was treated with supportive therapy and intravenous proton pump inhibitor and was discharged home 2 weeks later. Two weeks after discharge, the patient returned to the hospital with a painful swelling of the floor of his mouth. Biopsy again showed the same cancer type. He had unremitting bleeding from his mouth requiring multiple transfusions and a course of palliative radiation therapy. He progressively deteriorated in his cardiopulmonary and neurological functions and expired with cardiopulmonary arrest one month later.

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Late presentation of metastatic renal cell carcinoma as a bleeding ampullary mass

Cited by 33 publications

References 10 publications

Renal cell carcinoma to the pancreas in surgical pathology material

Renal cell carcinoma to the pancreas in surgical pathology material

Choledochal Cyst with a Rare Type of Anomalous Pancreaticobiliary Ductal Union

Massive Upper Gastrointestinal Bleeding Secondary to Duodenal Metastasis of Transitional Cell Carcinoma of the Urinary Bladder

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