Metastatic renal cell carcinoma to pancreas and gastrointestinal tract: a clinicopathological study of 3 cases and review of literature

Abstract

Background Renal Cell Carcinoma (RCC) metastasizes in approximately 20–30% cases. The most common sites for metastases are the lungs, bones, liver, and brain. Metastases of RCC in the gastrointestinal tract (GIT) are very rare. Metastatic RCC has a poor prognosis. We herein present a case series of three patients with metastatic disease in the colon, duodenum, and pancreas following complete resection of RCC. Methods Hematoxylin and Eosin and immunohistochemical slides of 3 cases of RCC metastatic to GIT were reviewed. These cases were diagnosed between 2002 and 2019 at French Medical Institute for Mothers and Children (FMIC), Kabul, Afghanistan, and Aga Khan University Hospital (AKUH), Karachi, Pakistan. We also present a detailed review of published literature. Results We reviewed cases of three patients, two females and one male, with a mean age of 57.3 years (range 40–67 years) who underwent nephrectomy for RCC. They developed metastases in the colon, pancreas, and duodenum, respectively 12–168 months (median time 156 months) following primary tumor resection. The patient with metastatic RCC in colon presented with abdominal pain and constipation. An ulcerated mass was found on colonoscopy 30 cm from the anal verge. Diagnosis of RCC with rhabdoid features was confirmed in both primary and metastatic tumors. The second patient developed a metastatic nodule in the head of pancreatic while the third patient developed metastatic nodules in the duodenum and pancreas which were detected by Computed Tomography (CT) scanning. Histopathological examination confirmed the presence of clear cell RCC in the metastatic nodules in both cases. Conclusion Metastatic RCC should be considered in the differential diagnosis of mass in the gastrointestinal (including pancreaticobiliary) tract especially in presence of a past history of RCC. These patients should be screened thoroughly by physical examination and appropriate imaging studies.

Metastatic Renal Cell Carcinoma to Pancreas: Case Series and Review of the Literature

“…With regard to the temporal relationship between RCC and PM, renal neoplasia can be diagnosed before or after detection of the pancreatic lesions [ 18 , 19 ]. Metachronous metastasis can occur long after primary tumor manifestation (up to 3 decades later) [ 20 , 21 ]. In our case series, the time to PM occurrence following nephrectomy varied from 6 months to 6 years.…”

“…Moreover, as reported in one of our cases, digestive involvement of RCC metastasis includes gastrointestinal tract (stomach, duodenum, colon), ampulla of Vater and gallbladder in addition to the pancreas. Metastases can occur simultaneously in GI sites, as in our case, or at different timepoints during follow-up [ 20 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 ].…”

A Novel Immune-Related Gene Prognostic Index (IRGPI) in Pancreatic Adenocarcinoma (PAAD) and Its Implications in the Tumor Microenvironment

“…The role of other immune cells should not be discounted either. Dendritic cells have been identified as an independent prognostic factor for PAAD [ 66 ], with lower circulating dendritic cell numbers resulting in a worse prognosis [ 67 ]. Tumor-associated macrophages also interface with tumor-associated neutrophils, with the overall effect of driving tumor progression through the promotion of hypoxia, vascular remodeling, fibrosis, immunosuppression, and metastasis formation [ 68 ].…”

MicroRNAs for detecting occult genitourinary cancer

“…Renal cancer (RC) is a challenge to diagnose, as a large percentage of patients with localized disease are asymptomatic or present only with minor symptoms [7]. Additionally, around 20% of renal cell carcinoma (RCC) patients, the most common form of renal cancer, present with metastasis when diagnosed [8]. Thus, biomarkers that would aid in early patient diagnosis and subtyping would be prized in this model [9].…”