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Todorovic Đ, Stojanovic B, Filip M, Đorđevic Đ, Stankovic M, Jovanovic I, Spasic M, Milosevic B, Cvetkovic A, Radovanovic D, Jovanovic M, Stojanovic BS, Pantic D, Cvetkovic D, Jovanovic D, Markovic V, Stojanovic MD. Small Bowel Perforation Due to Renal Carcinoma Metastasis: A Comprehensive Case Study and Literature Review. Diagnostics (Basel) 2024; 14:761. [PMID: 38611674 PMCID: PMC11011689 DOI: 10.3390/diagnostics14070761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 03/28/2024] [Accepted: 04/01/2024] [Indexed: 04/14/2024] Open
Abstract
This case report presents a unique instance of small bowel perforation caused by solitary metastasis from renal cell carcinoma (RCC), a rare and complex clinical scenario. The patient, a 59-year-old male with a history of RCC treated with nephrectomy four years prior, presented with acute abdomen symptoms. Emergency diagnostic procedures identified a significant lesion in the small intestine. Surgical intervention revealed a perforated jejunal segment due to metastatic RCC. Postoperatively, the patient developed complications, including pneumonia and multi-organ failure, leading to death 10 days after surgery. Histopathological analysis confirmed the metastatic nature of the lesion. This case underscores the unpredictable nature of RCC metastasis and highlights the need for vigilance in post-nephrectomy patients. The rarity of small bowel involvement by RCC metastasis, particularly presenting as perforation, makes this case a significant contribution to medical literature, emphasizing the challenges in the diagnosis and management of such atypical presentations.
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Affiliation(s)
- Đorđe Todorovic
- Department of Urology, University Clinical Center Kragujevac, 34000 Kragujevac, Serbia; (Đ.T.); (M.F.); (Đ.Đ.); (D.P.)
| | - Bojan Stojanovic
- Department of Surgery, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia; (M.S.); (B.M.); (A.C.); (D.R.)
| | - Milutinovic Filip
- Department of Urology, University Clinical Center Kragujevac, 34000 Kragujevac, Serbia; (Đ.T.); (M.F.); (Đ.Đ.); (D.P.)
| | - Đorđe Đorđevic
- Department of Urology, University Clinical Center Kragujevac, 34000 Kragujevac, Serbia; (Đ.T.); (M.F.); (Đ.Đ.); (D.P.)
| | - Milos Stankovic
- Department of Surgery, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia; (M.S.); (B.M.); (A.C.); (D.R.)
| | - Ivan Jovanovic
- Center for Molecular Medicine and Stem Cell Research, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia;
| | - Marko Spasic
- Department of Surgery, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia; (M.S.); (B.M.); (A.C.); (D.R.)
| | - Bojan Milosevic
- Department of Surgery, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia; (M.S.); (B.M.); (A.C.); (D.R.)
| | - Aleksandar Cvetkovic
- Department of Surgery, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia; (M.S.); (B.M.); (A.C.); (D.R.)
| | - Dragce Radovanovic
- Department of Surgery, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia; (M.S.); (B.M.); (A.C.); (D.R.)
| | - Marina Jovanovic
- Department of Internal Medicine, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia;
| | - Bojana S. Stojanovic
- Department of Pathophysiology, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia;
| | - Damnjan Pantic
- Department of Urology, University Clinical Center Kragujevac, 34000 Kragujevac, Serbia; (Đ.T.); (M.F.); (Đ.Đ.); (D.P.)
- Department of Surgery, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia; (M.S.); (B.M.); (A.C.); (D.R.)
| | - Danijela Cvetkovic
- Department of Genetics, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia;
| | - Dalibor Jovanovic
- Department of Pathology, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia; (D.J.); (M.D.S.)
| | - Vladan Markovic
- Department of Radiology, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia;
| | - Milica Dimitrijevic Stojanovic
- Department of Pathology, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia; (D.J.); (M.D.S.)
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Toro Tole D, Bowden J, Kamath S, Kaur M, LaPaglia D. Renal Cell Carcinoma Metastasis to the Small Bowel: A Rare Finding 10 Years After Nephrectomy. Cureus 2024; 16:e53141. [PMID: 38420097 PMCID: PMC10901038 DOI: 10.7759/cureus.53141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/28/2024] [Indexed: 03/02/2024] Open
Abstract
Renal cell carcinoma (RCC) most commonly metastasizes to the lung, lymph nodes, bone, and liver. RCC metastasizing to the small bowel is exceedingly rare (0.7%), and the ileum is the least likely site. We discuss the case of a 63-year-old male patient who presented with melena and a 10-kg unintentional weight loss in the preceding month 10 years after undergoing curative nephrectomy for RCC; he was found to have an ileal mass on CT imaging. He subsequently underwent a diagnostic gastroscopy and laparoscopy, later converted to a laparotomy, with bowel resection and anastomosis. The immunohistochemistry was consistent with RCC. This case report highlights the need for awareness about this rare but potential site of metastasis, which may present with gastrointestinal bleeding.
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Wasifuddin M, Gomez D' Aza DJ, Pokhrel A, Manvar K, Wang JC. Recurrent Left Renal Fossa Clear Cell Renal Cell Carcinoma With Pancreatic Tail Invasion Presenting as Intestinal Obstruction. Cureus 2023; 15:e47953. [PMID: 38034254 PMCID: PMC10685987 DOI: 10.7759/cureus.47953] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/30/2023] [Indexed: 12/02/2023] Open
Abstract
Distant renal cell carcinoma (RCC) metastatic disease is mostly seen in the lungs, bones, and lymph nodes. The incidence of local recurrences within the ipsilateral retroperitoneum (RFR) is very low. We report a case of a 79-year-old male with recurrent left renal fossa RCC with pancreatic tail invasion who presented with large bowel obstruction. To the best of our knowledge, no cases have been reported of recurrent left renal fossa RCC initially presenting as extrinsic large bowel obstruction.
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Affiliation(s)
- Mustafa Wasifuddin
- Internal Medicine, Brookdale University Hospital Medical Center, Brooklyn, USA
| | | | - Akriti Pokhrel
- Internal Medicine, Brookdale University Hospital Medical Center, Brooklyn, USA
| | - Kapilkumar Manvar
- Hematology and Medical Oncology, Brookdale University Hospital Medical Center, Brooklyn, USA
| | - Jen Chin Wang
- Hematology and Oncology, Brookdale University Hospital Medical Center, Brooklyn, USA
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Yang W, Cai Z, Nie P, Yuan T, Zhou H, Du Q, Qiu S, Zhang J, Yang L. Case report and literature review: Small bowel intussusception due to solitary metachronous metastasis from renal cell carcinoma. Front Oncol 2022; 12:1072485. [PMID: 36601471 PMCID: PMC9806257 DOI: 10.3389/fonc.2022.1072485] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 12/06/2022] [Indexed: 12/23/2022] Open
Abstract
Introduction Solitary metachronous small bowel metastasis from renal cell carcinoma (RCC) is rare. In contrast to idiopathic intussusception frequently occurring in children, adult intussusception is fairly uncommon and usually indicates a malignancy. Case presentation We presented an 84-year-old man with small bowel intussusception and obstruction due to a solitary metachronous metastasis from RCC. Computed tomography with intravenous contrast revealed small bowel obstruction and a 4 × 4 cm intraluminal soft-tissue mass with moderate enhancement. During urgent exploratory laparotomy, a pedunculated tumor of the distal ileum was found to be the lead point of intussusception. Hence, reduction of the intestinal invagination and segmental resection of the ileum with functional end-to-end anastomosis were performed. Histological examination finally confirmed the diagnosis. The postoperative recovery was uneventful. The patient was discharged without any complications on postoperative day 6. Conclusion The case report highlights the rarity of solitary metachronous small bowel metastases from RCC and suggests that life-long follow-up of RCC patients is critical due to its unpredictable behavior and the possibility of a long period of dormancy. Complete surgical resection remains the mainstay treatment for such patients.
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Affiliation(s)
- Wenming Yang
- Division of Gastrointestinal Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Zhaolun Cai
- Gastric Cancer Center, Department of General Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Pan Nie
- Department of Gastrointestinal Surgery, The Third People’s Hospital of Chengdu, Chengdu, China
| | - Tao Yuan
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, China
| | - Hang Zhou
- Division of Gastrointestinal Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Qiang Du
- Division of Gastrointestinal Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Siyuan Qiu
- Division of Gastrointestinal Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Jianhao Zhang
- Division of Gastrointestinal Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Lie Yang
- Division of Gastrointestinal Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu, China,*Correspondence: Lie Yang,
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Tan DTM, Phan YC, Hayes M, Akhtar M. A lesion in the jejunum: metastatic renal cell carcinoma. JOURNAL OF CLINICAL UROLOGY 2020. [DOI: 10.1177/2051415818792455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | | | - Mark Hayes
- The County Hospital, Wye Valley NHS Trust, UK
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Severe Small Bowel Bleeding Associated With Metastatic Clear Cell Renal Cell Carcinoma to the Jejunum. ACG Case Rep J 2020; 7:e00397. [PMID: 32637441 DOI: 10.14309/crj.0000000000000397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Accepted: 03/19/2020] [Indexed: 11/17/2022] Open
Abstract
Clear cell renal cell carcinoma is a malignancy of the kidneys that most commonly metastasizes to lung, bone, lymph nodes, liver, adrenal glands, and brain. We present a 75-year-old man with severe and chronic gastrointestinal bleeding who was eventually discovered to have clear cell renal cell carcinoma metastatic to his jejunum as the source of his bleed. This is a rare phenomenon and an unusual cause of gastrointestinal bleeding.
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Diaz de Leon A, Pirasteh A, Costa DN, Kapur P, Hammers H, Brugarolas J, Pedrosa I. Current Challenges in Diagnosis and Assessment of the Response of Locally Advanced and Metastatic Renal Cell Carcinoma. Radiographics 2019; 39:998-1016. [PMID: 31199711 DOI: 10.1148/rg.2019180178] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Locally advanced and metastatic renal cell carcinoma (RCC) present a specific set of challenges to the radiologist. The detection of metastatic disease is confounded by the ability of RCC to metastasize to virtually any part of the human body long after surgical resection of the primary tumor. This includes sites not commonly included in routine surveillance, which come to light after the patient becomes symptomatic. In the assessment of treatment response, the phenomenon of tumor heterogeneity, where clone selection through systemic therapy drives the growth of potentially more aggressive phenotypes, can result in oligoprogression despite overall disease control. Finally, advances in therapy have resulted in the development of immuno-oncologic agents that may result in changes that are not adequately evaluated with conventional size-based response criteria and may even be misinterpreted as progression. This article reviews the common challenges a radiologist may encounter in the evaluation of patients with locally advanced and metastatic RCC. ©RSNA, 2019.
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Affiliation(s)
- Alberto Diaz de Leon
- From the Department of Radiology (A.D.d.L., A.P., D.N.C., I.P.), Advanced Imaging Research Center (D.N.C., I.P.), Department of Pathology (P.K.), Department of Urology (P.K.), Kidney Cancer Program-Simmons Comprehensive Cancer Center (P.K., H.H., J.B., I.P.), and Department of Internal Medicine (H.H., J.B.), UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390
| | - Ali Pirasteh
- From the Department of Radiology (A.D.d.L., A.P., D.N.C., I.P.), Advanced Imaging Research Center (D.N.C., I.P.), Department of Pathology (P.K.), Department of Urology (P.K.), Kidney Cancer Program-Simmons Comprehensive Cancer Center (P.K., H.H., J.B., I.P.), and Department of Internal Medicine (H.H., J.B.), UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390
| | - Daniel N Costa
- From the Department of Radiology (A.D.d.L., A.P., D.N.C., I.P.), Advanced Imaging Research Center (D.N.C., I.P.), Department of Pathology (P.K.), Department of Urology (P.K.), Kidney Cancer Program-Simmons Comprehensive Cancer Center (P.K., H.H., J.B., I.P.), and Department of Internal Medicine (H.H., J.B.), UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390
| | - Payal Kapur
- From the Department of Radiology (A.D.d.L., A.P., D.N.C., I.P.), Advanced Imaging Research Center (D.N.C., I.P.), Department of Pathology (P.K.), Department of Urology (P.K.), Kidney Cancer Program-Simmons Comprehensive Cancer Center (P.K., H.H., J.B., I.P.), and Department of Internal Medicine (H.H., J.B.), UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390
| | - Hans Hammers
- From the Department of Radiology (A.D.d.L., A.P., D.N.C., I.P.), Advanced Imaging Research Center (D.N.C., I.P.), Department of Pathology (P.K.), Department of Urology (P.K.), Kidney Cancer Program-Simmons Comprehensive Cancer Center (P.K., H.H., J.B., I.P.), and Department of Internal Medicine (H.H., J.B.), UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390
| | - James Brugarolas
- From the Department of Radiology (A.D.d.L., A.P., D.N.C., I.P.), Advanced Imaging Research Center (D.N.C., I.P.), Department of Pathology (P.K.), Department of Urology (P.K.), Kidney Cancer Program-Simmons Comprehensive Cancer Center (P.K., H.H., J.B., I.P.), and Department of Internal Medicine (H.H., J.B.), UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390
| | - Ivan Pedrosa
- From the Department of Radiology (A.D.d.L., A.P., D.N.C., I.P.), Advanced Imaging Research Center (D.N.C., I.P.), Department of Pathology (P.K.), Department of Urology (P.K.), Kidney Cancer Program-Simmons Comprehensive Cancer Center (P.K., H.H., J.B., I.P.), and Department of Internal Medicine (H.H., J.B.), UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390
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Sadhale A, Adike A, Lam-Himlin D. Metastatic renal cell carcinoma presenting with melena. Clin Case Rep 2018; 6:961-962. [PMID: 29744101 PMCID: PMC5930209 DOI: 10.1002/ccr3.1492] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Revised: 01/16/2018] [Accepted: 02/24/2018] [Indexed: 11/09/2022] Open
Abstract
Renal cell carcinoma is a highly malignant neoplasm. Metastasis to the pancreas and gastrointestinal tract is rare. In this case report, we show images of metastatic renal cell carcinoma to the upper gastrointestinal tract in a patient who presented with melena.
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Affiliation(s)
- Ashwini Sadhale
- Department of Gastroenterology and Hepatology Mayo Clinic Scottsdale Arizona
| | - Abimbola Adike
- Department of Gastroenterology and Hepatology Mayo Clinic Scottsdale Arizona
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9
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Metastatic renal cell carcinoma to the small bowel: three cases of GI bleeding and a literature review. CEN Case Rep 2017; 7:39-43. [PMID: 29185198 DOI: 10.1007/s13730-017-0288-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Accepted: 11/16/2017] [Indexed: 12/15/2022] Open
Abstract
Approximately 25-30% of patients with renal cell carcinoma (RCC) have metastatic disease at the time of diagnosis, where the most common sites of metastasis are the lung (50-60% of patients with metastatic disease), bones (30-40%), liver (30-40%), and brain (5%). Although RCC metastasis to the small intestine is thought to be exceedingly rare, with predominantly isolated case reports and a few case series in the literature, we present below three additional cases at our institution of metastatic RCC to the small bowel presenting as GI bleeding. A literature review demonstrates that the number of published case reports has been increasing in recent years. We hypothesize that in the era of targeted chemotherapy and VEGF inhibitors to treat RCC that patients are living longer and have more time for their primary tumors to metastasize to the small bowel and become symptomatic, causing metastatic RCC to the small bowel to be less rare than previously thought.
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Trojaniello C, Vitale MG, Trojaniello B, Lentini Graziano ML, Coccaro M, Cartenì G, Montesarchio V. Severe blood loss anaemia and recurrent intussusceptions as first presentation of bowel metastatic renal cell carcinoma: A case report and review of the literature. Mol Clin Oncol 2017; 7:654-660. [PMID: 28855999 DOI: 10.3892/mco.2017.1365] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2016] [Accepted: 02/14/2017] [Indexed: 11/06/2022] Open
Abstract
Renal cell carcinoma (RCC) may metastasize to almost any organ, but bowel metastases are highly unusual. A 75-year-old man presented with symptoms and signs of severe anaemia due to bowel bleeding and abdominal pain due to recurrent bowel intussusception. The patient underwent surgery and was identified to have intraluminal metastases from metastatic RCC. To the best of our knowledge, few cases of metastases from RCC manifesting as synchronous intraluminal polypoid tumours have been described in the literature. The present report focused on the importance of two aspects that must be considered: The role of accurate diagnosis and of surgery treating intestinal metastases that may lead to symptom control and prolonged survival.
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Affiliation(s)
- Claudia Trojaniello
- Oncology Unit, Azienda Ospedaliera dei Colli, Ospedale Monaldi, I-80131 Naples, Italy
| | - Maria Giuseppa Vitale
- UOSC Oncologia Medica, Azienda Ospedaliera di Rilievo Nazionale 'Antonio Cardarelli', I-80131 Naples, Italy
| | - Biagio Trojaniello
- U.O. Urgenze Chirurgiche ed Accettazione Generale, Ospedale San Paolo ASL Napoli 1 Centro, I-80131 Naples, Italy
| | | | - Mariarosa Coccaro
- Oncology Unit, Azienda Ospedaliera dei Colli, Ospedale Monaldi, I-80131 Naples, Italy
| | - Giacomo Cartenì
- UOSC Oncologia Medica, Azienda Ospedaliera di Rilievo Nazionale 'Antonio Cardarelli', I-80131 Naples, Italy
| | - Vincenzo Montesarchio
- Oncology Unit, Azienda Ospedaliera dei Colli, Ospedale Monaldi, I-80131 Naples, Italy
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