Obstructive jaundice due to ampullary metastasis of renal cell carcinoma

Abstract

Renal cell carcinoma is often characterized by the presence of metachronous metastases in unusual sites. The presence of isolated metastases is treated with surgical excision with good anticipated results. On the other hand, systemic chemotherapy is administered in the context of metastatic spread, usually sunitib or sorafenib. In such cases, however, the presence of symptomatic foci calls for minimal intervention.We present a case of a 77-year-old patient who presented with obstructive jaundice due to an ampullary mass. Endoscopic excision and biopsy set the diagnosis of metastatic renal cell carcinoma. Consequently, imaging studies revealed the presence of multiple foci in the lungs and bone. Therefore, pancreatoduodenectomy was excluded and the patient underwent endoscopic ampullectomy and was set to oral sunitinib. Interestingly, despite generalized spread, local control was achieved until the patient succumbed to carcinomatosis.Painless obstructive jaundice in a patient with history of renal cancer and negative computed tomography scanning for pancreatic or other causes of obstruction should alert for prompt investigation for an ampullary metastasis.

Paraneoplastic hepatic dysfunction with jaundice in a case of primary renal synovial sarcoma: A very rare scenario

“…Presence of jaundice with raised liver enzymes in the presence of a suspected malignancy needs through evaluation to rule out liver metastasis and look for causes for hepatic dysfunction. Work up includes excluding any obstructive cause for jaundice like lymph nodes or malignant mass 5 at the porta hepatis, infectious causes like viral hepatitis A, B, C, relevant drug history, alcohol consumption. Involving a hepatologist for thorough evaluation in such cases and optimizing them prior to surgery is of paramount importance.…”

A Case of Obstructive Jaundice Caused by Metastasis of Ovarian Cancer to the Duodenal Major Papilla

“…In addition, many reported cases to date stated breast cancer, kidney cancer, or malignant melanoma as the primary lesion. [5][6][7][8][9] There is only one reported case of obstructive jaundice caused by ovarian cancer due to extramural pushing/infiltration from lymph node metastasis. 12 To the best of our knowledge, there has been no reported case of obstructive jaundice caused by direct metastasis to the duodenal major papilla.…”

“…Almost all intrabiliary tumors that cause obstructive jaundice originate in the biliary duct, although there are reports of rare cases of biliary/papillary metastasis arising from colorectal cancer, breast cancer, lung cancer, malignant melanoma, and other malignancies. [2][3][4][5][6][7][8][9] Obstructive jaundice caused by metastatic biliary tract/papillary lesions sometimes occurs because of compression or infiltration of bile ducts due to widespread liver metastases, or in exceptional cases, because of direct metastatic involvement of the extrahepatic bile ducts and duodenal major papilla in the absence of hepatic lesions. 7,10,11 We present a case of obstructive jaundice caused by direct metastasis to the duodenal major papilla from ovarian cancer that was treated surgically 11 years ago.…”

Renal Cell Carcinoma Presenting as an Ampullary Mass: A Case Report and Review of Literature

“…On review of literature, we found only 11 reported cases of RCC metastazing to ampulla of Vater. To our knowledge, this is the 12th case of RCC with metastasis to the ampulla ( Table 1 [ 5 - 8 , 17 - 21 ]). Of these cases, seven were males and five were females.…”