Chromophobe Renal Cell Carcinoma Masquerading as Obstructive Jaundice and Gastric Outlet Obstruction

Abstract

BACKGROUND: Chromophobe (Chr RCC) is a distinctive entity of Renal Cell Carcinoma (RCC) arising from cortical portion of collecting duct of kidneys with an incidence of 3-5% (1). Localized Cromophobe RCC suggests a better prognosis than other type of RCC but there is a poorer outcome with sarcomatoid features or metastatic disease (1). Renal cell carcinoma is one of the few tumors known to metastasize to the pancreas (2). Metastatic pancreatic cancer is rare, accounting for approximately 2% of all pancreatic malignancies, and most cases arise from renal cell carcinoma (3). Of patients with pancreatic metastases, 12% present with synchronous extra pancreatic metastasis, and they have a poor prognosis. Chromophobe RCC presenting as obstructive jaundice and gastric outlet obstruction has been cited infrequently in literature (3). The purpose of this paper is two: first, a rare case ChRCC with atypical presentation with obstructive jaundice, gastric outlet obstruction and pancreatic metastasis. Second, multidisciplinary treatment involving General surgeon, Medical Gastroenterologist, Surgical Gastroenterologist, Urologist, Interventional Radiologist and a Medical oncologist. CASE PRESENTATION: A 43 years old female presenting with features of obstructive jaundice and gastric outlet obstruction in surgical outpatient. A multidisciplinary management approach found Metastatic ChRCC the cause for gastrointestinal manifestation. CONCLUSIONS: ChRCC can be local invasion or metastatic. There are multiple sites where metastases can occur. There are many specific investigations to confirm RCC and concomitant gastric outlet obstruction (GOO), obstructive jaundice and pancreatic secondaries. This patient was diagnosed early after presentation of acute symptoms, decompression of biliary system done early by PTBD, Radical nephrectomy done with Portahepatis node which was causing obstructive jaundice and gastric outlet obstruction. Frozen section biopsy from pancreas and liver secondaries were positive for ChRCC. After surgery patient recovered without any immediate or late post-operative complications. Started on chemotherapy and doing well after 6 months follow up.