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Mega J, Roberts R, Shahin MM, Aal AKA. Renal cell carcinoma presenting with upper gastrointestinal bleeding: A case report. Radiol Case Rep 2022; 18:675-678. [PMID: 36504880 PMCID: PMC9727635 DOI: 10.1016/j.radcr.2022.10.075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 10/19/2022] [Accepted: 10/23/2022] [Indexed: 12/12/2022] Open
Abstract
Renal cell carcinoma (RCC) is increasing in incidence as more cross sectional imaging is performed with approximately 20%-30% of cases presenting with metastasis at the time of diagnosis. Small bowel metastatic disease is rare, with RCC to the small bowel being exceptionally rare. We present a case report of metastatic RCC that initially presented as upper gastrointestinal bleeding at time of diagnosis. We also provide a brief discussion of small bowel metastatic RCC disease and literature review.
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Affiliation(s)
- James Mega
- Department of Interventional Radiology, MD Anderson Cancer Center, 1400 Pressler St. Unit 1471, Houston, TX 77030, USA,Corresponding author.
| | - Rene Roberts
- Department of Interventional Radiology, MD Anderson Cancer Center, 1400 Pressler St. Unit 1471, Houston, TX 77030, USA
| | - Mohamed M Shahin
- Department of Diagnostic and Interventional Imaging, University of Texas Health Science Center at Houston (UTHelath), Houston, TX 77030, USA
| | - Ahmed Kamel Abdel Aal
- Department of Diagnostic and Interventional Imaging, University of Texas Health Science Center at Houston (UTHelath), Houston, TX 77030, USA
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2
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Application of 18F Prostate-Specific Membrane Antigen Positron Emission Tomography/Computed Tomography in Monitoring Gastric Metastasis and Cancer Thrombi from Renal Cell Carcinoma. JOURNAL OF ONCOLOGY 2022; 2022:5681463. [PMID: 35154318 PMCID: PMC8837453 DOI: 10.1155/2022/5681463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 01/11/2022] [Indexed: 11/17/2022]
Abstract
Background. Renal cell carcinoma (RCC) with gastric metastasis is rare, particularly accompanied by multiple cancer thrombi. Methods. We reported a 66-year-old man with a history of a right radical nephrectomy because of RCC. The patient underwent 18F prostate-specific membrane antigen (PSMA) positron emission tomography/computed tomography (PET/CT) scanning after 6 months of targeted therapy because of gastric metastasis and cancer thrombi. We conducted a systematic review of the literature and identified 73 cases of RCC with gastric metastasis. We analyzed the clinicopathological characteristics, therapies, and outcomes of patients. Results. 18F-PSMA PET/CT showed a large mass in the gastric fundus and cancer thrombi in the right atrium, inferior vena cava, and splenic vein with intense tracer uptake. Other metastases with increased tracer uptake included multiple bones and abdominal lymph nodes. The majority of gastric metastasis of RCC were men (53/73, 72.6%), with a median age at presentation of 67 (from 48 to 87) years. Gastric metastasis of RCC was mainly metachronous, and presented with small polyps or mass appearance and often accompanied by multiple-site metastases and gastrointestinal symptoms. An overall median interval between nephrectomy and diagnosis of gastric metastasis was 6 (from 0.1 to 23) years, and an overall median survival time was 14 (from 0.25 to 72) months. The median interval time of solitary gastric metastasis was longer than gastric metastasis with multiple-site metastases (7 vs.5 years;
). Patients with gastric and multiple-site metastases had higher mortality than patients with solitary metastasis (17 vs.1;
). The patients with synchronous gastric metastasis had a shorter survival time than metachronous gastric metastasis (6 vs.17 months;
). Conclusions. Postoperative follow-up of multiple imaging modalities to monitor recurrence and metastasis is necessary and important. PSMA PET/CT can improve the detection sensitivity of RCC, especially in metastatic clear cell renal cell carcinoma (ccRCC), and could provide a basis for disease staging, restaging, and therapeutic efficacy evaluation.
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3
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Are gastric metastases of renal cell carcinoma really rare? A case report and systematic review of the literature. Int J Surg Case Rep 2021; 82:105867. [PMID: 33839629 PMCID: PMC8055614 DOI: 10.1016/j.ijscr.2021.105867] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 03/30/2021] [Accepted: 03/31/2021] [Indexed: 12/23/2022] Open
Abstract
Solitary gastric metastasis of RCC are scarce. When feasible, surgical or endoscopic treatment of gastric metastasis should be performed. Risk of metastatic recurrence is significant and must be taken into consideration in the therapeutic strategy. Introduction Renal cell carcinoma (RCC) represents above 3 % of all cancers. At diagnosis, above 25 % of patients with RCC present an advanced disease. Gastric metastasis of RCC is associated with poor outcome. We report the case of a patient treated for a gastric metastasis of RCC and we conducted a systematic review of the literature to report all published cases of RCC patients with gastric metastasis. Case presentation In December 2010, a 61-year-old man was treated by open partial nephrectomy for a localized right clear cell RCC. In September 2018, a metachronous gastric metastasis was found on CT scan. The lesion was located on the lesser curvature of the stomach, measuring 4.5 cm long axis. No other secondary lesions were identified. A laparoscopic wedge resection, converted to laparotomy was performed. Two years later, in September 2020, a CT scan was performed, revealing a 17 mm adenopathy behind the hepatic hilum and a surgical management was performed, including a lymph node dissection of the hepatic hilum and the hepatic artery. Actually, he remains healthy. Clinical discussion and conclusion Our systematic review suggests that solitary gastric metastasis of RCC are scarce. In comparison of patients with multiple metastatic sites, the median survival of patients with solitary gastric metastasis is longer.
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Picchio M, Paioletti A, Santini E, Iacoponi S, Cordahi M. Gastric Metastasis from Renal Cell Carcinoma Fourteen Years after Radical Nephrectomy. Acta Chir Belg 2020. [DOI: 10.1080/00015458.2000.12098550] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- M. Picchio
- Department of Surgery, Civil Hospital of Acquapendente, Roma, Italy
| | - A. Paioletti
- Department of Surgery, Civil Hospital of Acquapendente, Roma, Italy
| | - E. Santini
- Department of Surgery, Civil Hospital of Acquapendente, Roma, Italy
| | - S. Iacoponi
- Department of Surgery, Civil Hospital of Acquapendente, Roma, Italy
| | - M. Cordahi
- Department of Surgery, Civil Hospital of Acquapendente, Roma, Italy
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Farrokh D, Rad MP, Mortazavi R, Akhavan R, Abbasi B. Local recurrence of renal cell carcinoma presented with massive gastrointestinal bleeding: management with renal artery embolization. CVIR Endovasc 2019; 2:10. [PMID: 32026999 PMCID: PMC6966418 DOI: 10.1186/s42155-019-0054-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2018] [Accepted: 02/25/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Gastrointestinal bleeding from renal cell carcinoma metastasis is an uncommon manifestation of tumor recurrence and is usually difficult to control. Palliative trans-catheter embolization to control the bleeding has been used and described in the literature. CASE PRESENTATION The present report describes a 62- years-old male with local recurrence of RCC who presented with upper GI bleeding as the primary manifestation 10 years after right-sided partial nephrectomy. A pseudoaneurysm of renal artery with erosion into the duodenal lumen was responsible for the massive bleeding and was controlled with coil embolization. CONCLUSION This case report highlights the importance of high index suspicion in post-nephrectomy patients for RCC, presenting with new symptoms. Aggressive gastrointestinal workup and adequate awareness of available minimally-invasive endovascular options for controlling GIB in these patients, are of paramount importance.
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Affiliation(s)
- Donya Farrokh
- Department of Radiology, Faculty of Medicine, Mashhad University of Medical Sciences, Imam Reza hops, Razi Sq, Mashhad, Iran
| | - Masoud Pezeshki Rad
- Department of Radiology, Faculty of Medicine, Mashhad University of Medical Sciences, Imam Reza hops, Razi Sq, Mashhad, Iran
| | - Reihaneh Mortazavi
- Department of Radiology, Faculty of Medicine, Mashhad University of Medical Sciences, Imam Reza hops, Razi Sq, Mashhad, Iran
| | - Reza Akhavan
- Department of Emergency Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Bita Abbasi
- Department of Radiology, Faculty of Medicine, Mashhad University of Medical Sciences, Imam Reza hops, Razi Sq, Mashhad, Iran.
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6
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Gastric Metastasis from Renal Cell Carcinoma, Clear Cell Type, Presenting with Gastrointestinal Bleeding. Case Rep Gastrointest Med 2017; 2017:5879374. [PMID: 28951791 PMCID: PMC5603082 DOI: 10.1155/2017/5879374] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Revised: 07/12/2017] [Accepted: 07/27/2017] [Indexed: 01/28/2023] Open
Abstract
Renal cell carcinoma (RCC) accounts for 80-85% of all primary renal neoplasms. Although RCC can metastasize to any organ, gastric metastases from RCC are exceedingly rare. A 67-year-old male presented with melena and acute blood loss anemia. The patient had a history of RCC that had been treated with a radical nephrectomy. He had a recent myocardial infarction and was receiving double antiplatelet therapy. After hemodynamic stabilization, esophagogastroduodenoscopy showed a polypoid mass in the gastric fundus. The mass was excised. Histological and immunohistochemical evaluation were consistent with clear cell RCC. The polypoid lesion is consistent with a late solitary metastasis.
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7
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Abstract
Interventional oncologists are playing an ever greater role in improving the quality of life of their patients through minimally invasive procedures, many of which can be performed on an outpatient basis. Some of the most common palliative procedures currently performed will be discussed including management of intractable ascites and pleural effusions, neurolytic plexus blocks, and palliation of pain and bleeding associated with metastatic tumors.
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8
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Foster D, Shaikh MF, Gleeson E, Babcock BD, Ringold D, Bowne WB. Palliative Surgery for Advanced Cancer: Identifying Evidence-Based Criteria for Patient Selection: Case Report and Review of Literature. J Palliat Med 2015; 19:22-9. [PMID: 26565437 DOI: 10.1089/jpm.2015.0146] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Criteria for selecting patients with advanced cancer for palliative surgery (PS) remains poorly defined. Decision making for PS requires realistic treatment goals with well-defined criteria. Here we discuss a 71-year-old Jehovah's Witness with advanced stage renal cell carcinoma (RCC) who presented with profound anemia due to intractable bleeding from gastric metastasis. After repeated attempts with endoscopic and angiographic management, she underwent surgical palliation. Through this case, we developed 10-item evidence-based criteria for selecting patients for PS. OBJECTIVE The study objective was to provide a review of pertinent literature for PS and identify evidence-based criteria for patient selection. These criteria were relevant for selecting this patient with metastatic RCC and may prove beneficial for selecting advanced cancer patients for PS. METHODS A MEDLINE search revealed 175 publications relevant to PS. Among these, 17 articles defining patient selection criteria (PSC) were reviewed. A frequency-based analysis of each criterion was performed. Another search returned 30 cases of RCC gastric metastases from 25 published reports. Outcome analysis was determined by the Kaplan-Meier actuarial method. RESULTS Ten criteria were identified: symptom control, prognosis, preoperative performance status, quality of life (QoL), tumor burden amenable to palliation, procedure-related morbidity and mortality, feasibility of nonsurgical therapies, anticipated hospitalization, requirement for additional palliation, and cost. This patient met all inclusion criteria and underwent a successful gastrectomy. Median survival for patients with RCC gastric metastasis was 20 months. CONCLUSIONS This report illustrates an example of implementation of evidence-based criteria for selecting advanced cancer patients for PS. Validation of these criteria is warranted.
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Affiliation(s)
- Deshka Foster
- 1 Department of Surgery, College of Medicine, Drexel University , Philadelphia, Pennsylvania
| | - Mohammad F Shaikh
- 1 Department of Surgery, College of Medicine, Drexel University , Philadelphia, Pennsylvania
| | - Elizabeth Gleeson
- 1 Department of Surgery, College of Medicine, Drexel University , Philadelphia, Pennsylvania
| | - Blake D Babcock
- 1 Department of Surgery, College of Medicine, Drexel University , Philadelphia, Pennsylvania
| | - Daniel Ringold
- 2 Department of Medicine, College of Medicine, Drexel University , Philadelphia, Pennsylvania
| | - Wilbur B Bowne
- 1 Department of Surgery, College of Medicine, Drexel University , Philadelphia, Pennsylvania
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9
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Transarterial embolization for gastrointestinal bleeding due to metastatic pancreatic tumors from renal cell carcinoma. Int Cancer Conf J 2015. [DOI: 10.1007/s13691-014-0169-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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10
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Costa TN, Takeda FR, Ribeiro U, Cecconello I. Palliative laparoscopic resection of renal cell carcinoma metastatic to the stomach: report of a case. World J Surg Oncol 2014; 12:394. [PMID: 25539876 PMCID: PMC4364342 DOI: 10.1186/1477-7819-12-394] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2014] [Accepted: 07/20/2014] [Indexed: 01/31/2023] Open
Abstract
The most common sites of metastases in renal cell carcinoma (RCC) are lung and bone. However, unusual sites, including the stomach, are characteristic of RCC.This article presents a case of a metastatic RCC (lung and liver) with a symptomatic gastric metastasis treated by a laparoscopic wedge resection (LWR).A 66-year-old woman, diagnosed with RCC underwent a right nephrectomy. During her follow-up, an upper gastrointestinal (GI) endoscopy showed an ulcerated lesion at the stomach. A biopsy of the specimen revealed metastatic RCC. The patient underwent a palliative LWR and was discharged home 8 days after surgery.Therefore, LWR is a relatively simple technique with the advantages of minimal invasive access in the treatment of palliative cases.
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Affiliation(s)
- Thiago Nogueira Costa
- Division of Digestive Surgery - Department of Gastroenterology, São Paulo State Cancer Institute - ICESP-HCFMUSP, University of Sao Paulo School of Medicine, Avenida Doutor Enéas de Carvalho, 255, São Paulo, SP Brazil
| | - Flavio Roberto Takeda
- Division of Digestive Surgery - Department of Gastroenterology, São Paulo State Cancer Institute - ICESP-HCFMUSP, University of Sao Paulo School of Medicine, Avenida Doutor Enéas de Carvalho, 255, São Paulo, SP Brazil
| | - Ulysses Ribeiro
- Division of Digestive Surgery - Department of Gastroenterology, São Paulo State Cancer Institute - ICESP-HCFMUSP, University of Sao Paulo School of Medicine, Avenida Doutor Enéas de Carvalho, 255, São Paulo, SP Brazil
| | - Ivan Cecconello
- Division of Digestive Surgery - Department of Gastroenterology, São Paulo State Cancer Institute - ICESP-HCFMUSP, University of Sao Paulo School of Medicine, Avenida Doutor Enéas de Carvalho, 255, São Paulo, SP Brazil
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11
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Gastric and esophageal metastases in renal cell carcinoma: systematic review and management options. Int Cancer Conf J 2014. [DOI: 10.1007/s13691-014-0202-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
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12
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Rita H, Isabel A, Iolanda C, Alexander H, Pedro C, Liliana C, Lucília M, Sofia S, Leopoldo M. Treatment of gastric metastases from renal cell carcinoma with endoscopic therapy. Clin J Gastroenterol 2014; 7:148-54. [DOI: 10.1007/s12328-014-0470-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2013] [Accepted: 02/20/2014] [Indexed: 12/23/2022]
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13
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NAMIKAWA TSUTOMU, MUNEKAGE MASAYA, KITAGAWA HIROYUKI, OKABAYASHI TAKEHIRO, KOBAYASHI MICHIYA, HANAZAKI KAZUHIRO. Metastatic gastric tumors arising from renal cell carcinoma: Clinical characteristics and outcomes of this uncommon disease. Oncol Lett 2012; 4:631-636. [PMID: 23205075 PMCID: PMC3506681 DOI: 10.3892/ol.2012.807] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2012] [Accepted: 07/11/2012] [Indexed: 02/05/2023] Open
Abstract
We analyzed the clinicopathological characteristics and therapeutic outcomes of patients with metastatic gastric tumors arising from renal cell carcinoma (RCC) to identify post-therapy prognostic factors. A total of 22 patients who were treated for metastatic gastric tumors arising from RCC were included in the study. A retrospective review was performed on the clinical characteristics of this disease. The median time interval from radical excision of the primary tumor to the detection of gastric metastasis (IGM) was 6.3 years. The overall 1- and 3-year survival rates were 52.6 and 21.0%, respectively, and the median survival time was 19 months. Compared with patients with an IGM of <6.3 years, patients with an IGM of ≥6.3 years showed a significantly longer median survival time (5 vs. 24 months; P=0.017). The median tumor size was significantly greater in patients with multiple metastases compared with those with solitary metastasis (4 vs. 2 cm; P=0.036). The incidence of patients who had undergone therapeutic tumor resection was significantly higher in patients with solitary metastasis compared with those with multiple metastases (100.0 vs. 35.7%; P=0.019). The appearance of gastric tumors in patients with a history of RCC should prompt the clinician to investigate the possibility of metastasis even several years after detection of the original renal cancer. A longer interval from nephrectomy to the diagnosis of gastric metastasis is generally indicative of a better prognosis, most likely the result of less aggressive tumor growth.
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Affiliation(s)
| | | | | | | | - MICHIYA KOBAYASHI
- Human Health and Medical Sciences, Kochi Medical School, Kochi 783-8505,
Japan
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14
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Xu J, Latif S, Wei S. Metastatic renal cell carcinoma presenting as gastric polyps: A case report and review of the literature. Int J Surg Case Rep 2012; 3:601-4. [PMID: 22989776 DOI: 10.1016/j.ijscr.2012.08.009] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2012] [Revised: 08/09/2012] [Accepted: 08/09/2012] [Indexed: 12/29/2022] Open
Abstract
INTRODUCTION Renal cell carcinoma (RCC) accounts for approximately 3% of adult malignancies and is responsible for over 13,000 deaths in the U.S. annually. The fatalities are largely due to distant metastasis, with lung, liver, bone and brain being most commonly affected organs. Gastric metastasis from RCC is a rare event (less than 20 cases reported in the English language literature) and usually presents as a large, solitary mass or ulcer (average size of 4.8cm) resembling primary gastric cancer. Here we report the first case of metastatic RCC presenting as small gastric polyps. PRESENTATION OF CASE The patient was a 60-year-old African American woman with a history of clear cell RCC (pT1bNX). She underwent esophagogastroduodenoscopy and colonoscopy 5months after nephrectomy due to anemia. Two non-ulcerated, 0.6-cm benign-appearing polyps were found at the greater curvature of the gastric body, which were subsequently removed endoscopically. Unexpectedly, histopathologic examination of the gastric polyps revealed nested collections of vacuolated epithelioid cells in a background of delicate, arborizing vasculature, immediately beneath the congested and hyperplastic foveolar epithelium. A diagnosis of metastatic RCC was rendered after confirming the renal epithelial origin by immunohistochemical stains. DISCUSSION Gastric metastasis from RCC usually presents as a large, solitary mass or ulcer, but it can be subtle and present as multiple, small benign-appearing polyps. CONCLUSION A careful follow up and thorough endoscopic and histopathologic examinations should be conducted in patients with a history of RCC who present with gastrointestinal manifestations.
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Affiliation(s)
- Jie Xu
- Department of Pathology, Division of Anatomic Pathology, University of Alabama at Birmingham, USA
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15
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Kim MY, Jung HY, Choi KD, Song HJ, Lee JH, Kim DH, Choi KS, Kim SA, Lee GH, Kim JH. Solitary synchronous metastatic gastric cancer arising from t1b renal cell carcinoma: a case report and systematic review. Gut Liver 2012; 6:388-94. [PMID: 22844570 PMCID: PMC3404179 DOI: 10.5009/gnl.2012.6.3.388] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2010] [Revised: 08/27/2010] [Accepted: 11/16/2010] [Indexed: 12/11/2022] Open
Abstract
Metastasis to the stomach from renal cell carcinoma (RCC) is extremely rare. Usually, gastric metastasis seems to be a late event in patients with RCC and is accompanied by disseminated tumor spread to other organs. Solitary synchronous gastric metastasis from small, localized RCC has rarely been reported. We report a case of 79-year-old man with synchronous gastric metastasis presenting with a single erosive lesion from pT1 RCC. The patient underwent radical nephrectomy and endoscopic resection for metastatic gastric cancer. The resected specimen showed an ill-defined tumor, approximately 0.6 cm long, with a clear resection margin. The morphologic features of the tumor cells were consistent with those of metastatic RCC of the clear cell type. At 6 months's follow-up, the patient did not show local recurrence or additional metastasis on upper endoscopy and computed tomography scan.
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Affiliation(s)
- Mi-Young Kim
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, and Asan Digestive Disease Research Institute, Seoul, Korea
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16
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Eslick GD, Kalantar JS. Gastric metastasis in renal cell carcinoma: a case report and systematic review. J Gastrointest Cancer 2011; 42:296-301. [PMID: 20514555 DOI: 10.1007/s12029-010-9165-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND Published report of cases of gastric metastases arising from renal cell carcinoma is a rare event and treatment of such patients can be difficult. Gastrectomy may be a surgical alternative; however, the prognosis for the majority of patients is very poor. METHODS We report a rare case of a patient with a metastatic renal cell carcinoma that metastasized to the stomach. In addition, we conducted a systematic review of the literature to assess the prevalence of reports and to gain a greater understanding of this particular metastatic cancer spread from the kidney to the stomach. RESULTS Published reports of metastases from the kidney to the stomach are not as rare as previously thought with three times of the number of reports found to what most authors thought actually existed. The majority of reports occurred among males (77%). The mean age of presentation was 65 years for males and 68 years for females (range, 40-84 years). Average time from nephrectomy to presentation of gastric metastases was 7 years for both males and females (range, 0-24 years). CONCLUSION Females with gastric metastases from the kidney are slightly older than males, and no difference exists between males and females in terms of the time interval between nephrectomy and subsequent metastasis or select patients treatment options.
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Affiliation(s)
- Guy D Eslick
- The Whiteley-Martin Research Centre Discipline of Surgery, The University of SydneySydney Medical School, Nepean, Penrith, NSW, Australia.
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Abstract
Massive upper gastrointestinal bleeding due to malignancy is relatively uncommon and the duodenum is the least frequently involved site. Duodenal metastasis is rare in renal cell carcinoma (RCC) and early detection, especially in case of a solitary mass, helps in planning further therapy. We report a case of intractable upper gastrointestinal bleeding from metastatic RCC to the duodenum. The patient presented with melena and anemia, 13 years after nephrectomy for RCC. On esophagogastroduodenoscopy, a submucosal mass was noted in the duodenum, biopsies of which revealed metastatic RCC. In conclusion, metastasis from RCC should be considered in nephrectomized patients presenting with gastrointestinal symptoms and a complete evaluation, especially endoscopic examination followed by biopsy, is suggested.
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Affiliation(s)
- Tarun Rustagi
- Department of Internal Medicine, University of Connecticut, Farmington, Conn., USA
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18
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Fidelman N, Freed RC, Nakakura EK, Rosenberg J, Bloom AI. Arterial embolization for the management of gastrointestinal hemorrhage from metastatic renal cell carcinoma. J Vasc Interv Radiol 2010; 21:741-4. [PMID: 20304675 DOI: 10.1016/j.jvir.2010.01.018] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2008] [Revised: 11/19/2009] [Accepted: 01/19/2010] [Indexed: 12/15/2022] Open
Abstract
Patients with renal cell carcinoma (RCC) involving the gastrointestinal (GI) tract may present with hemorrhage. Eight arterial embolization procedures were performed to treat five upper GI lesions and one ileal metastatic RCC lesion in five patients with GI bleeding. Control of GI hemorrhage for at least 30 days was achieved following six of the eight embolizations (75%) in four of the five patients (80%). Duration of response ranged from 1 to 26 months. Complications including GI ischemia and nontarget embolization were not encountered. Arterial embolization can be used safely for palliation of hemorrhage from RCC metastases to the GI tract.
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Affiliation(s)
- Nicholas Fidelman
- Department of Radiology, University of California, San Francisco, Room M-361, San Francisco, CA 94143, USA.
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19
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Sugasawa H, Ichikura T, Ono S, Tsujimoto H, Hiraki S, Sakamoto N, Yaguchi Y, Shimazaki H, Yamamoto J, Hase K. Isolated gastric metastasis from renal cell carcinoma 19 years after radical nephrectomy. Int J Clin Oncol 2010; 15:196-200. [DOI: 10.1007/s10147-010-0025-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2009] [Accepted: 07/28/2009] [Indexed: 12/18/2022]
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20
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Renal cell carcinoma: complete pathological response in a patient with gastric metastasis of renal cell carcinoma. Anticancer Drugs 2010; 21 Suppl 1:S13-5. [DOI: 10.1097/01.cad.0000361530.51675.60] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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21
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Upper Gastrointestinal Bleeding Revealing the Stomach Metastases of Renal Cell Carcinoma. J Gastrointest Cancer 2009; 40:51-4. [DOI: 10.1007/s12029-009-9074-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2009] [Accepted: 05/27/2009] [Indexed: 01/10/2023]
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22
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Pollheimer MJ, Hinterleitner TA, Pollheimer VS, Schlemmer A, Langner C. Renal cell carcinoma metastatic to the stomach: single-centre experience and literature review. BJU Int 2008; 102:315-9. [DOI: 10.1111/j.1464-410x.2008.07617.x] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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23
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Chehab BM, Dakhil SR, Nassif II. Melanoma metastatic to the duodenum presenting as upper GI bleed: 2 cases and a review of the literature. Gastrointest Endosc 2008; 67:998-1000. [PMID: 18241862 DOI: 10.1016/j.gie.2007.09.045] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2007] [Accepted: 09/25/2007] [Indexed: 12/15/2022]
Affiliation(s)
- Bassem M Chehab
- Department of Medicine, University of Kansas School of Medicine-Wichita, Kansas, Wichita, Kansas 67214, USA
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24
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25
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Chevallier P, Novellas S, Vanbiervliet G, Staccini P, Le Conte L, Hébuterne X, Bruneton JN. [Transcatheter embolization for endoscopically unmanageable acute nonvariceal upper gastrointestinal hemorrhage]. ACTA ACUST UNITED AC 2007; 88:251-8. [PMID: 17372552 DOI: 10.1016/s0221-0363(07)89811-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVES Evaluate the efficacy of endovascular embolization for patients with endoscopically unmanageable acute nonvariceal upper gastrointestinal hemorrhage as well as the factors that may influence mortality. MATERIALS AND METHODS. Retrospective study over a 4-year period including a historical cohort of 37 consecutive patients (22 men), with a mean age of 69.2 years (range, 22-93 years). In most cases (54%), the hemorrhage stemmed from a gastrointestinal ulcer. Technical, primary clinical, and secondary clinical success rates, as well as complication rates, were calculated. Several clinical and angiographic parameters were compared to the early mortality rate using Kruskal-Wallis or Fisher tests. RESULTS Technical, primary clinical, secondary clinical success rates, and complication rates were, respectively, 89.2%, 83.8%, 88.9%, and 10.8%. The early mortality rate was 32.4%. The APACHE II and IGS II scores were strongly correlated with mortality (p=0.001 and p=0.003, respectively). CONCLUSION Endovascular embolization in patients with endoscopically unmanageable acute nonvariceal upper gastrointestinal hemorrhage is effective. However, the mortality rate remains high because of the changes in the clinical condition of these patients.
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Affiliation(s)
- P Chevallier
- Service de d'Imagerie diagnostique et interventionnelle, Hôpotal Archet II, Nice Cedex 03, France.
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26
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Sadler GJ, Anderson MR, Moss MS, Wilson PG. Metastases from renal cell carcinoma presenting as gastrointestinal bleeding: two case reports and a review of the literature. BMC Gastroenterol 2007; 7:4. [PMID: 17266757 PMCID: PMC1800859 DOI: 10.1186/1471-230x-7-4] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2006] [Accepted: 01/31/2007] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Bleeding from small bowel neoplasms account for 1-4% of cases of upper gastrointestinal haemorrhage. Renal cell carcinoma constitutes 3% of all adult malignancies and often presents insidiously. Consequently 25-30% of patients have metastases at the time of diagnosis. Gastrointestinal bleeding from renal cell carcinoma metastases is an uncommon and under-recognised manifestation of this disease. CASE REPORT In this report we describe two cases of gastrointestinal bleeding from renal cell carcinoma metastases - in one patient bleeding heralded the primary manifestation of disease and in the other signified recurrence of disease following nephrectomy. CONCLUSION These cases highlight the importance endoscopic vigilance in cases of undiagnosed upper gastrointestinal haemorrhage, especially in patients with a past history of renal cell carcinoma.
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Affiliation(s)
- Gareth J Sadler
- Department of Gastroenterology, City Hospital, Dudley Road, Birmingham B18 7QH, UK
| | - Mark R Anderson
- Department of Gastroenterology, City Hospital, Dudley Road, Birmingham B18 7QH, UK
| | - Mark S Moss
- Department of Radiology, City Hospital, Dudley Road, Birmingham B18 7QH, UK
| | - Paul G Wilson
- Department of Gastroenterology, City Hospital, Dudley Road, Birmingham B18 7QH, UK
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27
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Riviello C, Tanini I, Cipriani G, Pantaleo P, Nozzoli C, Poma A, Riccardo V, Valeri A. Unusual gastric and pancreatic metastatic renal cell carcinoma presentation 10 years after surgery and immunotherapy: A case report and a review of literature. World J Gastroenterol 2006; 12:5234-6. [PMID: 16937540 PMCID: PMC4088027 DOI: 10.3748/wjg.v12.i32.5234] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Renal cell carcinoma (RCC) is the most common renal tumor, accounting for 2%-3% of all malignancies. Though RCC is known to spread hematogenously, isolated RCC metastasis to the stomach is a rare event. In this article, we describe the clinical course of a patient who developed a pancreatic recurrence of RCC and 1 year later a gastric recurrence of RCC treated 10 years ago with a resection and interleukin-2 (IL-2).
Accumulating evidence indicates that metastatic involvement of the pancreas and stomach should be suspected in any patient with a history of RCC who presents with gastrointestinal symptoms even 10 years after RCC resection and immunotherapy.
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Affiliation(s)
- Chiara Riviello
- Second Division of General and Vascular Surgery, Careggi Hospital, Florence, Italy.
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28
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Lamb GWA, Moss J, Edwards R, Aitchison M. Case Report: Octreotide as an Adjunct to Embolisation in the Management of Recurrent Bleeding Upper Gastrointestinal Metastases from Primary Renal Cell Cancer. Int Urol Nephrol 2005; 37:691-3. [PMID: 16362580 DOI: 10.1007/s11255-005-0251-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The recommended treatment for patients with severe bleeding from upper gastrointestinal (GI) metastases is embolisation. We report a case in which despite adequate embolisation major haemorrhage from renal cell carcinoma (RCC) gastric metastases continually recurred. During a severe bleed refractory to embolisation octreotide was used to control and prevent further bleeding. No further episodes of severe haemorrhage occurred over the following 23 months since starting treatment. Octreotide has been observed to be effective both in the acute management of persistent haemorrhage and in prevention of subsequent haematemesis from GI metastatic RCC.
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Affiliation(s)
- Gavin W A Lamb
- Department of Urology, Gartnavel General Hospital, 1053 Great Western Road, G12 0YN, Glasgow, UK.
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29
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Kobak J, Gandras EJ, Fleury L, Macura J, Shams J. Embolization for Treatment of Gastrointestinal Hemorrhage Secondary to Recurrent Renal Cell Carcinoma. Cardiovasc Intervent Radiol 2005; 29:1117-20. [PMID: 16328693 DOI: 10.1007/s00270-004-0095-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Massive gastrointestinal hemorrhage secondary to metastatic renal cell carcinoma involving the jejunum is rare but has been previously described in the medical literature. Treatment options for metastatic renal cell carcinoma are limited, but transcatheter arterial embolization can be performed to control gastrointestinal hemorrhage either alone or prior to surgical resection. We describe a case of successful transcatheter arterial embolization for control of massive gastrointestinal hemorrhage secondary to locally recurrent renal cell carcinoma invading the jejunum and review the literature. Arteriography provided both the diagnosis of recurrent disease and the means of therapy.
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Affiliation(s)
- Jeff Kobak
- Department of Radiology, SUNY Downstate Health Science Center, 450 Clarkson Avenue, Brooklyn, NY 11203, USA
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30
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Suárez Fonseca C, Carballido Rodríguez J, González Lama Y, Sola Galarza I, Rodríguez Reina G, Salas Antón C. [Gastric metastasis from renal cell carcinoma. Pathogenical hypothesis and literature revision]. Actas Urol Esp 2005; 28:472-6. [PMID: 15341401 DOI: 10.1016/s0210-4806(04)73114-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Secondary gastric tumours are very uncommon clinical entities and even more so when the site for the primary tumour is the kidney. Only 11 cases of life diagnosis have been described up to now. Contribution of one case report: a female patient presenting with upper GI tract haemorrhage secondary to gastric metastasis from renal cell carcinoma four years after radical nephrectomy. A literature review is made on the cases described up to date in living patients and a pathogenic hypothesis established based on the theoretical dissemination routes for the cases of gastric location of the metastasis.
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Affiliation(s)
- C Suárez Fonseca
- Servicio de Urología, Hospital Universitario Puerta de Hierro, Madrid
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31
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Mascarenhas B, Konety B, Rubin JT. Recurrent metastatic renal cell carcinoma presenting as a bleeding gastric ulcer after a complete response to high-dose interleukin-2 treatment. Urology 2001; 57:168. [PMID: 11164169 DOI: 10.1016/s0090-4295(00)00877-3] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Immunotherapy with high-dose recombinant interleukin-2 is an effective therapy for selected patients with metastatic renal cell carcinoma (RCC). Objective responses (complete or partial) are observed in about 15% of treated patients. The overall and disease-free survival of patients with a complete response are significantly prolonged. Although RCC is known to spread hematogenously, isolated RCC metastasis to the stomach is a rare event. Recurrent RCC, after a complete response to interleukin-2, presenting clinically as an isolated gastric metastasis, has not been reported to date. In this report, we describe the clinical course of a patient with metastatic RCC who had a complete response to high-dose interleukin-2 and was disease free for 4 years before presenting with massive upper gastrointestinal hemorrhage due to an isolated gastric metastasis. The patient remained disease free for 3 years after resection of the metastasis. Metastatic RCC to the stomach, although rare, should be suspected in any patient with a history of RCC who presents with gastrointestinal symptoms. In the absence of diffuse disease, aggressive therapy, including surgical resection, is appropriate for isolated gastric metastasis, because prolonged survival is possible.
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Affiliation(s)
- B Mascarenhas
- Department of Surgical Oncology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
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32
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Farthouat P, Faucompret S, Louis C, Debourdeau P, Pero C, Breda Y. [Gastrointestinal hemorrhage due to jejunal metastases from kidney cancer]. ANNALES DE CHIRURGIE 2000; 125:797-8. [PMID: 11105356 DOI: 10.1016/s0003-3944(00)00280-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Odori T, Tsuboi Y, Katoh K, Yamada K, Morita K, Ohara A, Kuroiwa M, Sakamoto H, Sakata T. A solitary hematogenous metastasis to the gastric wall from renal cell carcinoma four years after radical nephrectomy. J Clin Gastroenterol 1998; 26:153-4. [PMID: 9563931 DOI: 10.1097/00004836-199803000-00015] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- T Odori
- Department of Gastroenterology, Tosei General Hospital, Seto-city, Aichi, Japan
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