Diagnosis and Management of Massive Gastrointestinal Bleeding Owing to Duodenal Metastasis from Renal Cell Carcinoma

Lynch-Nyhan, Alma; Fishman, Elliot K.; Kadir, Saadoon

doi:10.1016/s0022-5347(17)43275-7

Cited by 50 publications

(13 citation statements)

References 4 publications

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“…Hemostasis of gastrointestinal bleeding occurring due to metastasis or invasion of malignant tumor is hard to manage endoscopically, and data on endoscopic therapy of bleeding from these duodenal lesions are limited. In selected cases, intractable gastrointestinal bleeding can be treated with arterial embolization of tumor-supplying arteries that has been reported to control gastrointestinal bleeding effectively, but there are no long-term follow-up data [17, 18, 19]. However, embolotherapy is only palliative while the tumor develops other collateral vessels and has potential for re-bleeding [20].…”

Section: Discussionmentioning

confidence: 99%

Duodenal Bleeding from Metastatic Renal Cell Carcinoma

Rustagi

Rangasamy²,

Versland³

2011

Case Rep Gastroenterol

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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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Section: Discussionmentioning

confidence: 99%

Duodenal Bleeding from Metastatic Renal Cell Carcinoma

Rustagi

Rangasamy²,

Versland³

2011

Case Rep Gastroenterol

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“…The conventional surgical treatment for metastasis in the head of the pancreas is pancreaticoduodenectomy. However, in some cases, partial resection of the duodenum, transarterial catheter embolization or radiation therapy are performed as less invasive treatments to avoid burden to the patients [9, 15]. Treatment for metastatic RCC should be individually tailored, with consideration of the patient's general condition and metastases at other sites.…”

Section: Discussionmentioning

confidence: 99%

Repeated Pancreatectomy for Metachronous Duodenal and Pancreatic Metastases of Renal Cell Carcinoma

Hata¹,

Sakata²,

Aoki³

et al. 2013

Case Rep Gastroenterol

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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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“…Patients after radical nephrectomy usually present within a year with recurrence but can present after many years, warranting lifelong surveillance [3] . RCC has the potential to metastasize to almost any site but the most common sites are lung (75%), lymph nodes (36%), bone (20%), liver (18%), adrenal glands, kidney, brain, heart, spleen, intestine and skin [4] . 4% of RCC metastasize to the GI tract and account for 7.1% of all metastatic tumors to the small intestine [4,5] .…”

Section: Discussionmentioning

confidence: 99%

“…RCC has the potential to metastasize to almost any site but the most common sites are lung (75%), lymph nodes (36%), bone (20%), liver (18%), adrenal glands, kidney, brain, heart, spleen, intestine and skin [4] . 4% of RCC metastasize to the GI tract and account for 7.1% of all metastatic tumors to the small intestine [4,5] . The duodenum is the least frequent site of metastasis, with the periampullary region the most common site followed by the duodenal bulb [3] .…”

Section: Discussionmentioning

confidence: 99%

Recurrent renal cell cancer presenting as gastrointestinal bleed

Cherian

Das²,

Garcha³

et al. 2011

WJGO

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We present an unusual case of renal cell cancer (RCC) which relapsed with duodenal metastasis and unveiled itself by gastrointestinal (GI) bleeding. An 80-year old Caucasian gentleman with history of renal cell cancer status post nephrectomy 11 mo previously, presented with syncope and melena. Computed tomography scan of the abdomen revealed heterogeneous soft tissue mass in the right nephrectomy bed invading the duodenum. Upper GI endoscopic biopsy confirmed the presence of recurrent renal cell cancer. However, due to extensive metastatic disease, the patient was placed on palliative chemotherapy as surgical options were ruled out. Our case report reiterates the fact that renal cell carcinoma can recur with gastrointestinal manifestations and, although a rarity, it should be considered in a patient with a history of malignancy who presents with these symptoms.

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Diagnosis and Management of Massive Gastrointestinal Bleeding Owing to Duodenal Metastasis from Renal Cell Carcinoma

Cited by 50 publications

References 4 publications

Duodenal Bleeding from Metastatic Renal Cell Carcinoma

Duodenal Bleeding from Metastatic Renal Cell Carcinoma

Repeated Pancreatectomy for Metachronous Duodenal and Pancreatic Metastases of Renal Cell Carcinoma

Recurrent renal cell cancer presenting as gastrointestinal bleed

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