Metastatic renal cell carcinoma to the small bowel: three cases of GI bleeding and a literature review

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.

An Unusual Case of Gastrointestinal Bleeding in Metastatic Renal Cell Carcinoma

“…A recent cohort study of over 3,000 patients described the prevalence of symptomatic small intestinal metastases from RCC as 0.71%, although post mortem studies have found a higher incidence at 2% [4, 5]. The ileum is the most common site of disease, with duodenal metastases from RCC being a much rarer phenomenon [3, 5].…”

“…There are less than 40 cases reported in the English language literature to date. With the advent of newer treatment strategies and the resulting improved survival, the incidence of gastrointestinal metastatic disease will become more common [3]. We present a case of metastatic RCC to the duodenum which was seen recently at our institution.…”

A lesion in the jejunum: metastatic renal cell carcinoma

“…This results in more time for the primary RCC to metastasise to the small bowel and become symptomatic. 5 The ways in which RCCs spread show remarkable variability, which can be haematogenous, lymphatic, transcoelomic, or by direct invasion. Given this unpredictable natural history, clinicians should thus have a low threshold for RCC metastasis.…”

Ein ungewöhnlicher Fall von gastrointestinaler Blutung bei metastasiertem Nierenzellkarzinom

“…Bis heute sind in der englischsprachigen Literatur weniger 40 Fälle dokumentiert. Mit dem Aufkommen neuer Behandlungsstrategien und dem daraus resultierenden verbesserten Überleben wird die Inzidenz gastrointestinaler Metastasen steigen [3]. In der vorliegenden Arbeit stellen wir den Fall eines Nierenzellkarzinoms mit Metastasierung ins Duodenum vor, der kürzlich in unserer Klinik aufgetreten ist.…”

“…Eine kürzlich durchgeführte Kohortenstudie mit mehr als 3.000 Patienten gab die Prävalenz von symptomatischen Dünndarmmetastasen eines RCC mit 0,71 % an, wobei die Inzidenz in Post-mortem-Studien jedoch bei 2 % lag [4, 5]. Bevorzugte Krankheitslokalisation ist das Ileum, während Duodenalmetastasen eines RCC sehr viel seltener auftreten[3, 5].…”