Simultaneous resection of gastric and gallbladder metastasis from renal cell carcinoma treated by laparoscopic and endoscopic cooperative surgery: a case report

Abstract

Background Metastases to the stomach or gallbladder from any malignancy is rarely noted, and simultaneous metastases to both organs are atypical. We present a unique case of simultaneous multifocal metastases of the stomach and gallbladder from renal cell carcinoma (RCC). Case presentation The case involved a 60-year-old man, with a past history of RCC (clear cell type, G2, T1b N0 M0 Stage I) treated by a right nephrectomy. Three years after the nephrectomy, a routine gastrointestinal endoscopy found an ulcerative lesion in the greater curvature of the gastric body. The gastric tumor was pathologically proven to be a metastasis from RCC. Furthermore, computed tomography incidentally revealed a mass lesion in the fundus of the gallbladder, which was also diagnosed as a potential metastasis from RCC. As endoscopic ultrasonography of the gastric tumor suggested the tumor potentially invaded to the submucosal layer, gastric wedge resection via a laparoscopic and endoscopic cooperative surgery (LECS) technique was applied to the gastric tumor, and laparoscopic cholecystectomy to the gallbladder tumor was simultaneously performed. Histological examination confirmed that the tumors of the stomach and gallbladder were both metastatic RCC. The hospitalization period after surgery was not eventful, and the patient was discharged on postoperative day 7. Thereafter, the patient required examination every 3 months, did not use anticancer agents, and has survived without relapse to 9 months after the surgery. Conclusions For patients with locally resectable RCC metastases, complete metastasectomy may bring long-term tumor control. Moreover, LECS for gastric metastasis is a reasonable approach for minimal invasiveness and an oncologically feasible outcome.

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.…”

“…With regard to treatment, the gastric metastasis was removed successfully via gastrointestinal endoscopy in 8 of the 16 patients (including our patient). 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.…”

“…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.…”

Imaging of gallbladder metastasis

“…However, even in these patients, GM is extremely uncommon [47]. Very few cases of RCC metastatic to the gallbladder are reported in literature [47][48][49][50][51][52]. In these studies, diagnosis was made more often using a combination of more imaging methods including US, CT, MRI, and endoscopic US.…”

“…In these studies, diagnosis was made more often using a combination of more imaging methods including US, CT, MRI, and endoscopic US. Among the cases reported in the literature, GM had no gastrointestinal symptoms in five cases [48][49][50][51][52]. Gastrointestinal symptoms, such as abdominal pain, nausea and vomiting, were reported in only one case [51].…”