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

Abstract

Renal cell carcinoma (RCC) has potential to present with distant metastasis several years after complete resection. The common sites of metastases include the lungs, bones, liver, renal fossa, and brain. RCCs metastasize rarely to the duodenum, and duodenal metastasis presenting with acute gastrointestinal bleed is infrequently reported in literature. We present a case of synchronous presentation of duodenal and azygoesophageal metastasis manifesting as acute upper gastrointestinal bleeding, four years after undergoing nephrectomy for RCC. The patient underwent further workup and was treated with radiation. The synchronous presentation is rare and stresses the importance of searching for recurrence of RCC in patients presenting with acute gastrointestinal bleeding.

Duodenal Metastases From Renal Cell Carcinoma Presented With Melena: Review and Case Report

“…It can involve any section of the bowel and accounts for 7.1% of all metastatic tumors to the small intestine ( 2 ). Duodenal metastasis from RCC is very rare and only few cases have been reported in the literature, also duodenal metastasis generally happens when there is abroad nodal and visceral involvement and clues for metastatic disease elsewhere in the body ( 2 , 3 ). Generally, RCC metastases occur many years after surgical resection, with recurrences reported up to 16 years after initial surgery ( 3 , 4 ).…”

“…Duodenal metastasis from RCC is very rare and only few cases have been reported in the literature, also duodenal metastasis generally happens when there is abroad nodal and visceral involvement and clues for metastatic disease elsewhere in the body ( 2 , 3 ). Generally, RCC metastases occur many years after surgical resection, with recurrences reported up to 16 years after initial surgery ( 3 , 4 ). Most patients of duodenal metastasis from RCC present with upper gastrointestinal bleeding or obstructive symptoms, and other signs include anemia, melena, fatigue and early satiety.…”

A case report of the pancreatic and periampullary metastases of renal cell carcinoma, 17 years after surgery

“…Recurrence of tumors at typical sites decreased, whereas retroperitoneal organ recurrence increased in a time-dependent manner, with a pancreatic metastatic rate of 2.7% (3). A periampullary metastasis from an RCC is reported to be sporadic, which is found only in 19 cases, including the present one (4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19). Perambulator metastases ordinarily emerges acute or chronic gastrointestinal hemorrhage (13/19), duodenal obstruction (4/19), duodenal ulcer (1/19), or obstructive jaundice (1/19).…”