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Lin RY, Shen S, Donabedian PL, Kiani C, Kresak JL, Chatzkel JA, Dakhoul L. Cecal Metastasis of Clear Cell Renal Cell Carcinoma After Previous Nephrectomy. ACG Case Rep J 2024; 11:e01352. [PMID: 38706450 PMCID: PMC11068133 DOI: 10.14309/crj.0000000000001352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 03/28/2024] [Indexed: 05/07/2024] Open
Abstract
Metastasis of renal cell carcinoma (RCC) to the gastrointestinal (GI) tract is exceedingly rare. We present a case of a man in his 40s with a history of RCC that had metastasized to his abdominal wall and brain who then presented with abdominal pain and melena. On presentation, imaging showed new bone metastases and a colonic mass in the ascending colon. The biopsy of the mass from colonoscopy demonstrated RCC primary. Although rare, this case report highlights the importance of a thorough evaluation of patients with a history of RCC and considers GI tract involvement in those presenting with GI bleeding.
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Affiliation(s)
- Rick Y. Lin
- Department of Medicine, University of Florida, Gainesville, FL
| | - Steve Shen
- Department of Medicine, University of Florida, Gainesville, FL
| | | | - Calvin Kiani
- Division of Gastroenterology, Hepatology & Nutrition, University of Florida, Gainesville, FL
| | - Jesse L. Kresak
- Department of Pathology, Immunology & Laboratory Medicine, University of Florida, Gainesville, FL
| | | | - Lara Dakhoul
- Division of Gastroenterology, Hepatology & Nutrition, University of Florida, Gainesville, FL
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Vohra M, Goyal H, Cen P, Joseph-Talreja M, Thosani N. A novel case of EUS-guided targeted radiofrequency ablation of metastatic duodenal renal cell carcinoma. Endosc Ultrasound 2023; 12:433-434. [PMID: 37969162 PMCID: PMC10631612 DOI: 10.1097/eus.0000000000000026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 06/01/2023] [Indexed: 11/17/2023] Open
Affiliation(s)
- Muhammad Vohra
- Department of Internal Medicine, McGovern Medical School, University of Texas Health Science Center, Houston, TX, USA
| | - Hemant Goyal
- Department of Internal Medicine, Center for Interventional Gastroenterology at UT (iGUT), Division of Gastroenterology, Hepatology, and Nutrition, The University of Texas Health Science Center, 6431 Fannin, MSB 4.234, Houston, TX 77030, USA
- Borland-Groover Clinic Jacksonville, Florida
| | - Putao Cen
- Division of Hematology-Oncology, University of Texas McGovern Medical School at Houston, Houston, TX, USA
| | - Mairin Joseph-Talreja
- Center for Interventional Gastroenterology at UT (iGUT), Division of Gastroenterology, Hepatology, and Nutrition, The University of Texas Health Science Center, 6431 Fannin, MSB 4.234, Houston, TX 77030, USA
| | - Nirav Thosani
- Center for Interventional Gastroenterology at UTHealth (iGUT), Division of Gastroenterology, Hepatology and Nutrition, McGovern Medical School, UTHealth, Houston, TX, USA
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Fan WJ, Cheng HH, Wei W. Surgical treatments of recurrent small intestine metastatic melanoma manifesting with gastrointestinal hemorrhage and intussusception: A case report. World J Gastrointest Oncol 2023; 15:205-214. [PMID: 36684046 PMCID: PMC9850767 DOI: 10.4251/wjgo.v15.i1.205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Revised: 11/24/2022] [Accepted: 12/13/2022] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Melanoma is the most aggressive form of skin cancer, with a tendency to metastasize to any organ. Malignant melanoma is the most frequent cause of skin cancer-related deaths worldwide. Small intestine cancers especially small intestine metastases are relatively rare. Small intestine metastases are seldom described and likely underdiagnosed. Intussusception is most common in pediatric age, and in adults are almost 5% of all cases.
CASE SUMMARY A 75-year-old man with a history of acral malignant melanoma was admitted to the Gastroenterology Department of our hospital, complaining of intermittent melena for 1 mo. Magnetic resonance enterography showed partial thickening of the jejunal wall and formation of a soft tissue mass, indicating a neoplastic lesion with jejunojejunal intussusception. The patient underwent partial small bowel resection. Pathological findings and immunohistochemical staining indicated small intestine metastatic melanoma. The patient refused further anti-tumor treatment after the surgery. Ten months after the first surgery, the patient presented with melena again. Computed tomography enterography showed the anastomotic stoma was normal without thickening of the intestinal wall, and routine conservative treatment was given. Three months later, the patient developed melena again. The patient underwent a second surgery, and multiple metastatic melanoma lesions were found. The patient refused adjuvant anti-tumor treatment and was alive at the latest follow-up.
CONCLUSION Small intestine metastatic melanoma should be suspected in any patient with a history of malignant melanoma and gastrointestinal symptoms.
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Affiliation(s)
- Wen-Juan Fan
- Department of Gastroenterology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China
- Hubei Key Laboratory of Hepato-Pancreato-Biliary Diseases, Wuhan 430030, Hubei Province, China
| | - Heng-Hui Cheng
- Institution of Pathology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China
| | - Wang Wei
- Department of Gastroenterology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China
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González J, Gaynor JJ, Ciancio G. Renal Cell Carcinoma with or without Tumor Thrombus Invading the Liver, Pancreas and Duodenum. Cancers (Basel) 2021; 13:cancers13071695. [PMID: 33916652 PMCID: PMC8038355 DOI: 10.3390/cancers13071695] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 03/12/2021] [Accepted: 03/28/2021] [Indexed: 11/29/2022] Open
Abstract
Simple Summary Renal cell carcinoma rarely invades the surrounding visceral structures. While surgical extirpation has been the mainstay of treatment for the localized disease, the role of surgery in cases of venous involvement, adjacent invasion or distant metastasis remains controversial. Furthermore, the surgical option may represent a challenge. A large series of locally advanced renal cancer with involvement of the liver, pancreas, and/or duodenum, sometimes in conjunction with tumor thrombus extending inside the inferior vena cava is herein reported. Our series establishes the technical feasibility of this complex surgical procedure with acceptable complication rates, no perioperative death, and potential for durable response. With the use of new systemic therapy schedules, these patients will probably have a better opportunity of survival extension. Abstract Background: The purpose of this study is to report the outcomes of a series of patients with locally advanced renal cell carcinoma (RCC) who underwent radical nephrectomy, tumor thrombectomy, and visceral resection. Patients and methods: 18 consecutive patients who underwent surgical treatment in the period 2003-2019 were included. Neoplastic extension was found extending into the pancreas, duodenum, and liver in 9(50%), 2(11.1%), and 7(38.8%) patients, respectively. Seven patients (38.8%) presented also inferior vena cava tumor thrombus level I (n = 3), II (n = 2), or III (n = 2). The resection was tailored according to the degree of invasiveness. Demographics, clinical presentation, disease characteristics, surgical details, 30-day postoperative complications, and overall survival (OS) were analyzed. Results: Median age was 56 years (range: 40–76). Median tumor size was 14.5 cm (range, 8.8–22), and 10 cm (range: 4–15) for those cases with pancreatico-duodenal and liver involvement, respectively. Median estimated blood loss (EBL) was 475 mL (range: 100–4000) and resulted higher for those cases requiring thrombectomy (300 mL vs. 750 mL). Nine patients (50%) required transfusions with a median requirement of 4 units (range: 2–8). No perioperative deaths were registered in the first 30 days. Overall complication rate was 44.4%. Major complications were detected in 6/18 patients (33.3%). Overall median follow-up was 24 months (range: 0–108). Five-year OS (actuarial) rate was 89.9% and 75%, for 9/11 patients with pancreatico-duodenal involvement and 6/7 patients with liver invasion, respectively. Conclusion: Our series establishes the technical feasibility of this procedure with acceptable complication rates, no deaths, and potential for durable response.
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Affiliation(s)
- Javier González
- Department of Urology, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain;
| | - Jeffrey J. Gaynor
- Department of Surgery, Miami Transplant Institute, University of Miami Miller school of Medicine, Miami, FL 33136, USA;
| | - Gaetano Ciancio
- Department of Surgery, Miami Transplant Institute, University of Miami Miller school of Medicine, Miami, FL 33136, USA;
- Department of Surgery and Urology, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, FL 33136, USA
- Correspondence:
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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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Jain N, Bharat A, Ludhwani D, Khaddour K, Weyburn T. Delayed Recurrence of Chromophobe Renal Cell Carcinoma Presenting as Metastatic Duodenal Ulcer. Cureus 2020; 12:e9154. [PMID: 32789090 PMCID: PMC7417324 DOI: 10.7759/cureus.9154] [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] [Indexed: 11/14/2022] Open
Abstract
Renal cancers are one of the common causes of cancer-related morbidity and mortality worldwide. Most primary cases are localized at presentation and are treated with partial or radical nephrectomy with curative intent. However, renal cell carcinoma (RCC) is known for its potential recurrence, sometimes several years after initial management. Many of these recurrent cases commonly metastasize to the liver, kidney, or bone and herald a poor prognosis. We present a case study of nonclear cell RCC, which recurred 33 years after nephrectomy and masqueraded as a duodenal ulcer -- an extremely rare site for metastasis. This is unique as it describes a presentation only sparingly documented in the medical literature and highlights a more extended period of recurrence than currently reported. Moreover, our patient’s tumor was chromophobe cell variety, a rare sub-type of nonclear cell RCC, which to our knowledge has never been known to cause duodenal metastasis. Studies have implicated a prognostic role of lymph node involvement at the time of initial diagnosis to predict future recurrence. This case is a drop in the mighty ocean to prompt further investigation on the utility of life-long surveillance protocols and further research evaluating the role of lymph node dissection in preventing such recurrences and high mortality.
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Affiliation(s)
- Nikita Jain
- Internal Medicine, Chicago Medical School, Rosalind Franklin University of Medicine and Science, McHenry, USA
| | - Anchit Bharat
- Internal Medicine, Indiana University Health Ball Memorial Hospital, Muncie, USA
| | - Dipesh Ludhwani
- Internal Medicine, Rosalind Franklin University of Medicine and Science, North Chicago, USA.,Internal Medicine, Chicago Medical School, North Chicago, USA
| | - Karam Khaddour
- Internal Medicine, Chicago Medical School, Rosalind Franklin University, McHenry, USA
| | - Thomas Weyburn
- Hematology and Oncology, Advocate Health Care, Crystal Lake, USA
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