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Tanaka H, Komori S, Suetsugu T, Iwata Y, Watanabe T, Tanaka C, Nagao N, Noguchi K, Hisamatsu K, Katayama M, Kawai M. Concomitant pancreatic and duodenal metastases 12 years after nephrectomy for renal cell carcinoma: a case report. J Surg Case Rep 2024; 2024:rjae276. [PMID: 38706478 PMCID: PMC11068445 DOI: 10.1093/jscr/rjae276] [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] [Received: 02/27/2024] [Accepted: 04/10/2024] [Indexed: 05/07/2024] Open
Abstract
In selected patients with metastatic renal cell carcinoma, metastasectomy can achieve prolonged survival. Herein we report a patient with concomitant pancreatic and duodenal metastases occurring 12 years after total right nephrectomy for a renal cell carcinoma. The metastases were successfully treated by a pancreas-sparing duodenectomy and distal pancreatectomy. A 66-year-old man was referred to our hospital with a chief complaint of right upper abdominal pain. He had undergone laparoscopic total right nephrectomy for renal cell carcinoma 12 years before. Enhanced computed tomography showed hypervascular tumors in the pancreatic body and the descending duodenum near the papilla of Vater. Histopathological examination of endoscopic ultrasonography-guided fine needle aspiration cytology specimens revealed metastatic clear cell renal cancer. The patient underwent pancreas-sparing duodenectomy and distal pancreatectomy. He developed a pancreatic fistula after surgery that improved with conservative treatment, and has been free of evidence of recurrence up to 20 months postoperatively.
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Affiliation(s)
- Hideharu Tanaka
- Department of Surgery, Gifu Prefectural General Medical Center, 4-6-1, Noishiki, Gifu, Gifu 500-8717, Japan
| | - Shuji Komori
- Department of Surgery, Gifu Prefectural General Medical Center, 4-6-1, Noishiki, Gifu, Gifu 500-8717, Japan
| | - Tomonari Suetsugu
- Department of Surgery, Gifu Prefectural General Medical Center, 4-6-1, Noishiki, Gifu, Gifu 500-8717, Japan
| | - Yoshinori Iwata
- Department of Surgery, Gifu Prefectural General Medical Center, 4-6-1, Noishiki, Gifu, Gifu 500-8717, Japan
| | - Taku Watanabe
- Department of Surgery, Gifu Prefectural General Medical Center, 4-6-1, Noishiki, Gifu, Gifu 500-8717, Japan
| | - Chihiro Tanaka
- Department of Surgery, Gifu Prefectural General Medical Center, 4-6-1, Noishiki, Gifu, Gifu 500-8717, Japan
| | - Narutoshi Nagao
- Department of Surgery, Gifu Prefectural General Medical Center, 4-6-1, Noishiki, Gifu, Gifu 500-8717, Japan
| | - Kei Noguchi
- Department of Pathology, Gifu Prefectural General Medical Center, 4-6-1, Noishiki, Gifu, Gifu 500-8717, Japan
| | - Kenji Hisamatsu
- Department of Pathology, Gifu Prefectural General Medical Center, 4-6-1, Noishiki, Gifu, Gifu 500-8717, Japan
| | - Masaki Katayama
- Department of Pathology, Gifu Prefectural General Medical Center, 4-6-1, Noishiki, Gifu, Gifu 500-8717, Japan
| | - Masahiro Kawai
- Department of Surgery, Gifu Prefectural General Medical Center, 4-6-1, Noishiki, Gifu, Gifu 500-8717, Japan
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2
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Maelle R, Jean-Philippe R, Jochen W, Geraldine P, Fabrice C, Christian P, Mathilde G, Slimane D, Serge B, Naji S, Cecile V, Stanislas R, Thomas M, Sami F, Manuel T, Marc G, Gwenaelle G. Gastrointestinal Metastases From Primary Renal Cell Cancer: A Single Center Review. Front Oncol 2021; 11:644301. [PMID: 33833995 PMCID: PMC8023271 DOI: 10.3389/fonc.2021.644301] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Accepted: 02/23/2021] [Indexed: 12/19/2022] Open
Abstract
Introduction: Digestive metastases (DMs) from renal cell cancer (RCC) are rare. Over the past decade, the overall survival of metastatic RCC (mRCC) has been improved by tyrosine kinase inhibitors (TKIs) and immune checkpoint inhibitors. The main objective of this study was to assess the incidence of metastases of the digestive tract in this new field of treatment. The secondary objectives were to evaluate the clinical characteristics, prognosis, treatments used for DMs, and median time between the diagnosis of RCC or mRCC and DMs. Materials and Methods: A retrospective analysis of data collected from all patients with mRCC between 2007 (the time of TKI was a standard of care) and 2019 was carried out at the Paoli-Calmettes Institute (Marseille, France). Computer research software using artificial intelligence (ConSoRe®) was used to identify patients and assess their characteristics. Results: Between January 2007 and December 2019, 11 out of 660 (1.6%) mRCC patients had metastases of the gastrointestinal tract. The median age was 62 years. Of the 11 patients, 81.8% experienced digestive bleeding or anemia. Only 2 patients were asymptomatic. The metastases were mainly duodenal (50%) and gastric (41.6%). The median time from cancer diagnosis and from metastatic disease to gastrointestinal metastasis was 4.3 years (3 months-19.2 years) and 2.25 years (0 days-10.2 years), respectively. Local treatment was performed in 38.5% of cases by endoscopy (60%), surgery (20%) and radiotherapy (40%) with success rates of 33, 100, and 50%, respectively. Etiological treatment was modified following the discovery of DM in 84.6% of the cases. The median survival was 1 year from the diagnosis of DM (13 days-9.4 years). Two patients were still alive 2.9 and 9.4 years after the diagnosis of DM. Conclusion: This is the largest monocentric retrospective analysis of DM in patients with RCC. It seems to be a rare and late event in the course of the disease. Local treatment combined with systemic treatment could improve survival. In the context of prolonged survival with the new based immunotherapy treatments in mRCC, we suggest that unexplained anemia or persistent digestive symptoms could be explored by endoscopy.
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Affiliation(s)
- Rony Maelle
- Paoli-Calmettes Institute, Department of Gastrointestinal Disease, Marseille, France
| | - Ratone Jean-Philippe
- Paoli-Calmettes Institute, Department of Gastrointestinal Disease, Marseille, France
| | - Walz Jochen
- Paoli-Calmettes Institute, Department of Urology, Marseille, France
| | - Pignot Geraldine
- Paoli-Calmettes Institute, Department of Urology, Marseille, France
| | - Caillol Fabrice
- Paoli-Calmettes Institute, Department of Gastrointestinal Disease, Marseille, France
| | - Pesenti Christian
- Paoli-Calmettes Institute, Department of Gastrointestinal Disease, Marseille, France
| | - Guerin Mathilde
- Paoli-Calmettes Institute, Department of Medical Oncology, Marseille, France
| | - Dermeche Slimane
- Paoli-Calmettes Institute, Department of Medical Oncology, Marseille, France
| | - Brunelle Serge
- Paoli-Calmettes Institute, Department of Radiology, Marseille, France
| | - Salem Naji
- Paoli-Calmettes Institute, Department of Radiotherapy, Marseille, France
| | - Vicier Cecile
- Paoli-Calmettes Institute, Department of Medical Oncology, Marseille, France
| | | | - Maubon Thomas
- Paoli-Calmettes Institute, Department of Urology, Marseille, France
| | - Fakhfakh Sami
- Paoli-Calmettes Institute, Department of Urology, Marseille, France
| | - Tejeda Manuel
- Paoli-Calmettes Institute, Department of Informatics, Marseille, France
| | - Giovannini Marc
- Paoli-Calmettes Institute, Department of Gastrointestinal Disease, Marseille, France
| | - Gravis Gwenaelle
- Paoli-Calmettes Institute, Department of Medical Oncology, Aix-Marseille University, Inserm, CNRS, CRCM, Marseille, France
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3
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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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4
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Baghmar S, Shasthry SM, Singla R, Patidar Y, Bihari CB, Sarin SK. Solitary Duodenal Metastasis from Renal Cell Carcinoma with Metachronous Pancreatic Neuroendocrine Tumor: Review of Literature with a Case Discussion. Indian J Med Paediatr Oncol 2019. [DOI: 10.4103/ijmpo.ijmpo_214_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
AbstractRenal cell cancinoma (RCC) is a unique malignancy with features of late recurrences, metastasis to any organ, and frequent association with second malignancy. It most commonly metastasizes to the lungs, bones, liver, renal fossa, and brain although metastases can occur anywhere. RCC metastatic to the duodenum is especially rare, with only few cases reported in the literature. Herein, we review literature of all the reported cases of solitary duodenal metastasis from RCC and cases of neuroendocrine tumor (NET) as synchronous/metachronous malignancy with RCC. Along with this, we have described a unique case of an 84-year-old man who had recurrence of RCC as solitary duodenal metastasis after 37 years of radical nephrectomy and metachronous pancreatic NET.
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Affiliation(s)
- Saphalta Baghmar
- Departments of Medical Oncology, Institute of Liver and Biliary Sciences, New Delhi, India
| | - S M Shasthry
- Departments of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Rajesh Singla
- Departments of Medical Oncology, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Yashwant Patidar
- Departments of Radiology, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Chhagan B Bihari
- Departments of Pathology, Institute of Liver and Biliary Sciences, New Delhi, India
| | - S K Sarin
- Departments of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India
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5
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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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Ignatavicius P, Lizdenis P, Pranys D, Gulbinas A, Pundzius J, Barauskas G. Long-term Survival of Patient with Ampulla of Vater Metastasis of Renal Cell Carcinoma. Prague Med Rep 2019; 119:165-169. [DOI: 10.14712/23362936.2019.4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
Ampulla of Vater metastases from renal cell carcinoma are rare. The time between detection of the primary tumour and its metastasis may extend to years. Management should be aggressive, since the prognosis of renal cell carcinoma is unpredictable and curative surgery of metastases may extend patient survival and even lead to definite cure. Herein we report a case of long-term survival after successful surgical treatment of a renal cell carcinoma metastasis to the ampulla of Vater. A 62-year-old man with a history of renal cell carcinoma in the left kidney underwent a successful left nephrectomy. Eight months later duodenoscopy showed a tumour at the site of papilla of Vater. Biopsy confirmed the diagnosis of carcinoma. Contrast enhanced computer tomography scan verified the periampullary mass, dilatation of the pancreatic and the common bile duct. No radiological signs of either local advancement or distant metastases were present. Pylorus-preserving pancreatoduodenectomy with lymphadenectomy was performed. Pathology report disclosed metastatic lesions in the papilla of Vater from the clear cell carcinoma of the kidney. The postoperative course was uneventful, and the patient lived for 14 years after pancreatoduodenectomy and, following thorough investigations, was free from local and systemic recurrence. Pancreatoduodenectomy can provide long-term survival in selected cases with solitary papilla of Vater metastasis from renal cell carcinoma. Favourable long-term survival rates suggest that these patients should be considered candidates for pancreatoduodenectomy if experienced pancreatic surgeon is available and no other metastases are found.
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7
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Ojha U, Ojha V. Renal cell carcinoma presenting as nonspecific gastrointestinal symptoms: a case report. Int Med Case Rep J 2018; 11:345-348. [PMID: 30568516 PMCID: PMC6267697 DOI: 10.2147/imcrj.s178816] [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] [Indexed: 01/23/2023] Open
Abstract
Background Renal cell carcinoma (RCC) arises from the renal epithelium and accounts for more than 90% of kidney cancers. RCC has a diverse range of clinical manifestations. The classical triad of loin pain, hematuria and abdominal mass is only present in 4%–17% of cases. Here, we demonstrate a unique case of RCC presenting as upper gastrointestinal (GI) symptoms without any specific GI involvement. Case presentation A 49-year-old man, presented with ongoing severe heartburn, nausea and vomiting for 5 months. The patient further complained of weight loss over the last 2 months. Routine blood tests were normal except raised C-reactive protein and ALP. Examination revealed a large and tender liver, and he was subsequently referred under the upper GI cancer pathway. Esophagogastroduodenoscopy showed hiatus hernia and gastritis. CT scan revealed an 11 and 9 mm nodule in the left and right lung, respectively. There was a further metastatic 13×7 cm2 mass in the liver and 10×8 cm2 mass arising from the upper pole of the left kidney with convincing evidence of tumor thrombus in left renal vein. The patient was promptly referred under the care of the oncologist team and died within months. Conclusion The classical triad of loin pain, hematuria and abdominal mass for RCC is not that common and RCC should be suspected in patients complaining of upper GI pain with nonspecific symptoms. Furthermore, it is not necessary that patients complaining of “heartburn” have a GI cause, as pathology in other thoracic organs present in a similar manner.
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Affiliation(s)
- Utkarsh Ojha
- Imperial College School of Medicine, Imperial College London, London, UK,
| | - Vinod Ojha
- Willow Bank Surgery, NHS, Stoke-on-Trent, UK
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8
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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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9
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Park HJ, Kim HJ, Park SH, Lee JS, Kim AY, Ha HK. Gastrointestinal Involvement of Recurrent Renal Cell Carcinoma: CT Findings and Clinicopathologic Features. Korean J Radiol 2017; 18:452-460. [PMID: 28458597 PMCID: PMC5390614 DOI: 10.3348/kjr.2017.18.3.452] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Accepted: 12/21/2016] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE To retrospectively evaluate the CT findings and clinicopathologic features in patients with gastrointestinal (GI) involvement of recurrent renal cell carcinoma (RCC). MATERIALS AND METHODS The medical records were reviewed for 15 patients with 19 pathologically proven GI tract metastases of RCC. The CT findings were analyzed to determine the involved sites and type of involvement; lesion size, morphology, and contrast enhancement pattern; and occurrence of lymphadenopathy, ascites and other complications. RESULTS The most common presentation was GI bleeding (66.7%). The average interval between nephrectomy and the detection of GI involvement was 30.4 ± 37.4 months. GI lesions were most commonly found in the ileum (36.8%) and duodenum (31.6%). A distant metastasis (80%) was more common than a direct invasion from metastatic lesions. The mean lesion size was 34.1 ± 15.0 mm. Intraluminal polypoid masses (63.2%) with hyperenhancement (78.9%) and heterogeneous enhancement (63.2%) were the most common findings. No patients had regional lymphadenopathy. Complications occurred in four patients, with one each of bowel obstruction, intussusception, bile duct dilatation, and pancreatic duct dilatation. CONCLUSION GI involvement of recurrent RCC could be included in the differential diagnosis of patients with heterogeneous, hyperenhanced intraluminal polypoid masses in the small bowel on CT scans along with a relative paucity of lymphadenopathy.
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Affiliation(s)
- Hyo Jung Park
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Korea
| | - Hyun Jin Kim
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Korea
| | - Seong Ho Park
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Korea
| | - Jong Seok Lee
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Korea
| | - Ah Young Kim
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Korea
| | - Hyun Kwon Ha
- Department of Radiology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung 25440, Korea
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10
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Omranipour R, Mahmoud Zadeh H, Ensani F, Yadegari S, Miri SR. Duodenal Metastases From Renal Cell Carcinoma Presented With Melena: Review and Case Report. IRANIAN JOURNAL OF PATHOLOGY 2017. [PMID: 29531553 PMCID: PMC5835376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Renal cell carcinoma (RCC) metastasis to duodenum is very rare and only a few case reports are available in the literature. We here reported a patient with solitary duodenal metastasis presented with melena six years after right nephrectomy. The patient underwent upper gastrointestinal endoscopy showing ulcerative mass at the second portion of duodenum and biopsy of this mass was consistent with metastatic RCC. Metastasis work up did not find any other site of malignancy, thus Whipple's operation (Pancreaticoduodenectomy) was performed. In conclusion metastasis from RCC should be considered in mind in patients with history of nephrectomy presenting with gastrointestinal symptoms and a complete evaluation, especially endoscopic examination followed by biopsy, is suggested.
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Affiliation(s)
- Ramesh Omranipour
- Cancer Institute of Tehran University of Medical Science, Tehran, Iran
| | | | - Fershteh Ensani
- Research Center of Cancer, Tehran University of Medical Science, Tehran, Iran
| | - Samira Yadegari
- Cancer Institute of Tehran University of Medical Science, Tehran, Iran
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11
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Emergency arterial embolization of upper gastrointestinal and jejunal tumors: An analysis of 12 patients with severe bleeding. Diagn Interv Imaging 2017; 98:51-56. [DOI: 10.1016/j.diii.2016.04.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Revised: 04/11/2016] [Accepted: 04/14/2016] [Indexed: 12/21/2022]
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12
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Mohamed MO, Al-Rubaye S, Reilly IW, McGoldrick S. Renal cell carcinoma presenting as an upper gastrointestinal bleeding. BMJ Case Rep 2015; 2015:bcr-2015-211553. [PMID: 26276850 DOI: 10.1136/bcr-2015-211553] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
An 80-year-old man presented with melaena and anaemia of 1 week duration. This was associated with shortness of breath and an indigestion-type pain for the preceding 8 weeks. General physical examination revealed epigastric tenderness, but an otherwise soft abdomen with no organomegaly. The patient had a gastroscopy, showing a polypoidal lesion in the second part of duodenum (D2) as the bleeding point, which was managed with epinephrine injection and endoclips. This was followed by CT of the abdomen, revealing a lobulated 8 cm mass arising from the lower pole of the right kidney and invading the duodenum. The case report aims to acknowledge the possibility of direct duodenal involvement in renal cell carcinoma, which is a rare occurrence.
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Affiliation(s)
| | - Sinan Al-Rubaye
- Department of Gastroenterology, Aintree University Hospitals, Lower Lane, Liverpool, Liverpool, UK
| | - Ian William Reilly
- Department of Gastroenterology, Wirral University Teaching Hospital NHS FT, Wirral, UK
| | - Stephen McGoldrick
- Department of Gastroenterology, Mid Cheshire Hospitals NHS Foundation Trust, Crewe, UK
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13
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An obscure cause of gastrointestinal bleeding: Renal cell carcinoma metastasis to the small bowel. Int J Surg Case Rep 2015; 15:130-2. [PMID: 26348395 PMCID: PMC4601954 DOI: 10.1016/j.ijscr.2015.08.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2015] [Revised: 08/03/2015] [Accepted: 08/09/2015] [Indexed: 12/12/2022] Open
Abstract
Renal cell carcinoma metastasis to the small intestine is a rare condition. It usually results in gastrointestinal bleeding and it could happen many years after the diagnosis with renal cell cancer. Treatment includes surgery as well as targeted agents such as tyrosine kinases. We report here the case of an 82-year-old man with a past medical history of high-grade renal cell carcinoma and right nephrectomy 6 years earlier, who presented with recurrent episodes of syncope and black stools. He underwent esophagogastroduodenoscopy (EGD) and colonoscopy without evident source of bleeding. Video capsule endoscopy (VCE) showed three bleeding lesions in the jejunum and ileum. Push enteroscopy revealed a proximal jejunum bleeding mass that was suspicious for malignancy. Histopathology demonstrated poorly differentiated carcinoma. Given the patient's history of high-grade renal cell carcinoma, and similarity of histologic changes to the old renal cell cancer specimen, metastatic renal cell carcinoma was felt to be the responsible etiology.
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14
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Geramizadeh B, Mostaghni A, Ranjbar Z, Moradian F, Heidari M, Khosravi MB, Malekhosseini SA. An unusual case of metastatatic renal cell carcinoma presenting as melena and duodenal ulcer, 16 years after nephrectomy; a case report and review of the literature. IRANIAN JOURNAL OF MEDICAL SCIENCES 2015; 40:175-80. [PMID: 25821299 DOI: pmid/25821299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 06/18/2013] [Revised: 08/18/2013] [Accepted: 09/08/2013] [Indexed: 12/05/2022]
Abstract
Renal cell carcinoma comprises about 2% of adult tumors. The overall 10-year survival rate of patients with RCC after nephrectomy is about 18-27%. The incidence of metastasis of initial RCC is about 24-28%, but this rate after nephrectomy is as high as 51%. The most common site of recurrence is the lung, however liver and bone metastases are common. There are many reported cases with late metastasis, however isolated late metastasis in the gastrointestinal tract especially duodenum is very rare. Herein we report our experience with a case of gastrointestinal bleeding secondary to metastatic renal cell carcinoma to duodenum, 16 years after nephrectomy. To the best of our knowledge, about 30 of such cases have been reported in the English literature. Many of the previous cases have been part of disseminated disease and isolated duodenal metastasis is very rare. The longest reported duration between nephrectomy for renal cell carcinoma and duodenal metastasis has been 13 years, thus it seems our case to be also unique because of very late duodenal metastasis.
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Affiliation(s)
- Bita Geramizadeh
- Shiraz Transplant Research Center, Nemazee Hospital, Shiraz University of Medical Sciences, Shiraz, Iran; ; Department of Pathology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - AmirAhmad Mostaghni
- Department of Internal Medicine, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Zeinab Ranjbar
- Department of Pathology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Farid Moradian
- Department of Surgery, Shahid Faghihi Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mina Heidari
- Department of Pathology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Bagher Khosravi
- Department of Anesthesiology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Seyed Ali Malekhosseini
- Department of Surgery, Shahid Faghihi Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
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Emergency Pancreatoduodenectomy with Preservation of Gastroduodenal Artery for Massive Gastrointestinal Bleeding due to Duodenal Metastasis by Clear Cell Renal Cell Carcinoma in a Patient with Celiac Artery Stenosis. Case Rep Surg 2014; 2014:218953. [PMID: 25177508 PMCID: PMC4142743 DOI: 10.1155/2014/218953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2014] [Accepted: 07/29/2014] [Indexed: 11/18/2022] Open
Abstract
Duodenal metastasis from renal cell carcinoma is rare, and even rarer is a massive gastrointestinal bleeding from such tumours. Coeliac occlusive disease, although rarely symptomatic, can lead to ischaemic changes with anastomotic dehiscence and leaks when a patient undergoes pancreatoduodenectomy. A 41-year-old man with known metastasis to the adrenal glands and the second part of the duodenum close to the ampulla of Vater from clear cell renal cell carcinoma was admitted to our department due to massive gastrointestinal bleeding from the duodenal metastasis. Endoscopic control of the bleed was not possible, while the bleeding vessel embolization was able to control the haemorrhage only temporarily. An angiography during the embolization demonstrated the presence of stenosis of the coeliac artery and also hypertrophic inferior pancreaticoduodenal arteries supplying the proper hepatic artery via the gastroduodenal artery (GDA). The patient underwent emergency pancreatoduodenectomy with preservation of the gastroduodenal artery. The patient had an uneventful recovery and did not experience further bleeding. Also the blood flow to the liver was compromised as shown by the normal liver function tests (LFTs) postoperatively. To the best of our knowledge, this is the first report of a preservation of the GDA during an emergency pancreatoduodenectomy.
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Espinoza E, Hassani A, Vaishampayan U, Shi D, Pontes JE, Weaver DW. Surgical excision of duodenal/pancreatic metastatic renal cell carcinoma. Front Oncol 2014; 4:218. [PMID: 25177547 PMCID: PMC4132479 DOI: 10.3389/fonc.2014.00218] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Accepted: 07/30/2014] [Indexed: 12/15/2022] Open
Abstract
Renal cell carcinoma (RCC) has a potential to metastasize to almost any site and this may occur many years following nephrectomy. We present six cases with uncommon sites of metastasis: four patients presented with distal pancreatic metastasis and two with duodenal/head of the pancreas metastasis. Time to metastatic disease varied from 1 to 19 years following renal surgery. For patients are alive and two succumbed to their disease. Long-term survival can be achieved with aggressive surgical excision of disease.
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Affiliation(s)
- Eduardo Espinoza
- Surgical Oncology Division, Karmanos Cancer Institute , Detroit, MI , USA ; Cayetano Heredia, Peruvian University , Lima , Peru
| | - Ali Hassani
- Surgical Oncology Division, Karmanos Cancer Institute , Detroit, MI , USA
| | - Ulka Vaishampayan
- Medical Oncology Division, Karmanos Cancer Institute , Detroit, MI , USA
| | - Dongping Shi
- Department of Pathology, Karmanos Cancer Institute , Detroit, MI , USA
| | - J Edson Pontes
- Department of Urology, Karmanos Cancer Institute , Detroit, MI , USA
| | - Donald W Weaver
- Surgical Oncology Division, Karmanos Cancer Institute , Detroit, MI , USA
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17
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Abstract
OBJECTIVE The differential diagnosis between primary pancreatic neoplasms versus pancreatic metastases (PM) is challenging. Endoscopic ultrasonography with fine-needle aspiration can be used to differentiate primary versus metastatic tumors although with a suboptimal accuracy. Recently, contrast harmonic EUS (CH-EUS) has been reported as an adjunct in the diagnosis of pancreatic neoplasms. We evaluated the potential role of CH-EUS in the differential diagnosis of PM. METHODS This study is a retrospective analysis of a prospectively maintained database. Of the 266 patients, 4.1% were diagnosed with PM. Endoscopic ultrasonography with fine-needle aspiration and/or surgical pathology represented our criterion standard. RESULTS The origins of PM were renal cancer (3 patients), colon cancer(2 patients), breast cancer (2 patients), ovarian cancer (1 patient), melanoma(1 patient), lymphoma (1 patient), and sarcoma (1 patient). All lesions appeared hypoechoic at standard EUS. At CH-EUS, of the 11 lesions, 6 appeared hypoenhancing (colon cancer, sarcoma, and breast and ovarian cancer), 4 were hyperenhancing (renal cancer and lymphoma),and 1 was isoenhancing (melanoma). CONCLUSIONS In our population, standard EUS features of PM were unremarkable. At CH-EUS, most of the PM appeared hypoenhancing suggesting a possible malignant origin. However, a subset of PM showed hyperenhancing pattern. In the appropriate context, particularly when cancer history is present, CH-EUS may add to the differential diagnosis and potentially spare endoscopic ultrasonography with fine-needle aspiration.
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Hata T, Sakata N, Aoki T, Yoshida H, Kanno A, Fujishima F, Motoi F, Masamune A, Shimosegawa T, Unno M. Repeated pancreatectomy for metachronous duodenal and pancreatic metastases of renal cell carcinoma. Case Rep Gastroenterol 2013; 7:442-8. [PMID: 24403883 PMCID: PMC3884199 DOI: 10.1159/000355884] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
A 50-year-old woman had undergone left nephrectomy for renal cell carcinoma 13 years previously. Ten years later, a solitary metastatic tumor had been detected in the pancreatic tail and she had undergone subsequent resection of the pancreatic tail and spleen. Three years after surgery, she was admitted to our hospital for severe anemia resulting from gastrointestinal tract bleeding. Esophagogastroduodenoscopy revealed a 3-cm solid tumor at the oral side of the papilla of Vater. Histology of the bioptic duodenal tissue revealed inflammatory granulation without malignancy. Computed tomography showed a well-contrasted hypervascular tumor in the descending portion of the duodenum. We diagnosed the patient with metachronous duodenal metastasis of renal cell carcinoma and performed a pancreaticoduodenectomy. An ulcerated polypoid mass was detected at the oral side of the papilla of Vater. Histology revealed clear cell carcinoma coated by granulation tissue across the surface of the tumor. Immunohistology demonstrated that the cells were positive for vimentin, CD10 and epithelial membrane antigen and negative for CK7. After a repeated pancreatectomy, the patient had no symptoms of gastrointestinal bleeding and maintained good glucose tolerance without insulin therapy because the remnant pancreas functioned well. In conclusion, for the diagnosis of patients who have previously undergone nephrectomy and present with gastrointestinal bleeding, the possibility of metastasis to the gastrointestinal tract, including the duodenum, should be considered. With respect to surgical treatment, the pancreas should be minimally resected to maintain a free surgical margin during the first surgery taking into account further metachronous metastasis to the duodenum and pancreas.
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Affiliation(s)
- Tatsuo Hata
- Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Sendai, Japan
| | - Naoaki Sakata
- Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Sendai, Japan
| | - Takeshi Aoki
- Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Sendai, Japan
| | - Hiroshi Yoshida
- Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Sendai, Japan
| | - Atsushi Kanno
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | | | - Fuyuhiko Motoi
- Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Sendai, Japan
| | - Atsushi Masamune
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Tooru Shimosegawa
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Michiaki Unno
- Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Sendai, Japan
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19
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Management of locally advanced renal cell carcinoma with invasion of the duodenum. Case Rep Surg 2013; 2013:596362. [PMID: 23691422 PMCID: PMC3638526 DOI: 10.1155/2013/596362] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2013] [Accepted: 03/11/2013] [Indexed: 12/28/2022] Open
Abstract
Renal cell carcinoma (RCC) is rare but aggressive, with greater than 20% of patients presenting with stage III or IV, disease. Surgical resection of the primary tumor regardless of stage is the treatment of choice, and en bloc resection of involved organs provides the only potential chance for cure. This case report describes a patient with metastatic right-sided RCC with invasion of the inferior vena cava and duodenum managed by en block resection and pancreaticoduodenectomy. This report will review the workup and treatment of locally advanced RCC, as well as the role of cytoreductive nephrectomy in the setting of metastatic disease.
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