Recurrent renal cell cancer presenting as gastrointestinal bleed

Abstract

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.

Surgical Excision of Duodenal/Pancreatic Metastatic Renal Cell Carcinoma

“…A majority of duodenal metastases, around 70%, occur from the right kidney due to the greater risk of regional invasion, as the patients we present (3, 6, 15). …”

Recurrent Renal Cell Carcinoma with Synchronous Tumor Growth in Azygoesophageal Recess and Duodenum: A Rare Cause of Anemia and Upper Gastrointestinal Bleeding

“…There have been 28 cases of isolated metastasis to the duodenum reported so far [4]. The majority of patients are found to have duodenal metastasis within the first three years after nephrectomy, though it can be seen even after several years [5]. The routes of spread can be (i) peritoneal dissemination, (ii) direct spread from an intra-abdominal malignancy, (iii) hematogenous spread, and (iv) lymphatic spread.…”

Metastatic renal cell carcinoma mimicking diverticulitis in a patient with chronic lymphocytic leukaemia

“…GI bleeding as the presenting symptom of RCC has been rarely documented 21. When present, bleeding is often limited to the upper GI tract and is typically associated with recurrent cases of RCC rather than initial presentation 5 19 22–24. There are less than 10 reported cases of metastatic RCC presenting with lower GI bleeding 18 21 25 26.…”

“…However, less than 10% of patients actually present with these symptoms 3 4. Consequently, 25–30% of patients with RCC have metastases at time of diagnosis, most often involving the lungs (75%), lymph nodes (36%), bone (20%) and liver (18%) 5. Median survival rate for patients with metastatic RCC varies by prognostic factors;6 however, median overall survival has been estimated at 13 months, and 5-year survival is estimated at less than 10% 7.…”