Metastatic renal cell carcinoma presenting as chronic bleeding from the stomach: a rare case report

Abstract

Renal cell carcinoma (RCC) most commonly metastasizes to the lung, adrenals, brain and pancreas, but metastasis to the stomach is uncommon. We present a 77-year-old male who underwent left nephrectomy 9 years previously for RCC with known metastatic disease to the lungs, diaphragm and stomach, and required multiple transfusions for acute blood loss anemia. A previous esophagogastroduodenoscopy revealed a large, friable, ulcerated mass at the gastric cardia. Biopsies of the mass demonstrated clear-cell carcinoma compatible with metastatic RCC. After multiple attempts at endoscopic, procedures and embolization were unsuccessful at controlling bleeding, the patient was treated with palliative total gastrectomy with Roux-en-Y gastric bypass. At discharge, the patient had been hemodynamically stable and tolerating a liquid diet. This case report highlights the presenting symptomology of RCC, explores the rarity of gastric metastases, and reviews current literature on management strategies for these patients.

Gastric metastasis of renal cell carcinoma treated with endoscopic resection: A case report

“…Some clinical case reports with gastric metastasis of RCC have been published, based on our literature investigation. [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16] We summarized a literature review of 16 case reports of gastric metastasis of RCC that were conducted in recent years (Table 1). The pathology of all cases of RCC was ccRCC, except one case for which the pathology was not reported.…”

“…2,5,7,8,11,12,14 Five patients needed invasive surgeries such as laparoscopic or open gastrectomy. 4,[13][14][15][16] Other patients required radiation therapy 6,9 or molecular target drug therapy. 3,16 A gastric tumor can supposedly be resected via gastrointestinal endoscopy only, if clinicians detect a gastric metastasis in the early stage.…”

“…summarized the anatomical sites of 740 metastasectomies of RCC and reported that the metastatic sites of RCC are the lungs (36%), bone (13%), nonregional lymph node (9%), ipsilateral adrenal gland (8%), contralateral adrenal gland (8%), pancreas (8%), contralateral retroperitoneum (5%), and liver (3%), whereas gastric metastasis of RCC is uncommon. Some clinical case reports with gastric metastasis of RCC have been published, based on our literature investigation 2–16 . We summarized a literature review of 16 case reports of gastric metastasis of RCC that were conducted in recent years (Table 1).…”

“…1 However, the time interval between the primary diagnosis of RCC and the occurrence of gastric metastasis is more than 10 years. [2][3][4][5][6][7] The treatment of gastric metastasis of RCC requires endoscopy, 2,3,5,7-12 laparoscopy, 4,13,14 total gastrectomy, 15 radiation, 6,9 or chemotherapy. 3,16 We report a patient with gastric metastasis of RCC who was treated with endoscopic resection.…”

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 ].…”