Triple jejuno-jejunal intussusception due to metastatic renal cell carcinoma

Abstract

We report on a 61-year-old man who was referred to the accident and emergency department with recurrent episodes of vomiting and diffuse abdominal pain for 1 week prior to admission. The patient also reported frequent constipation and intermittent melaena. He had undergone tumour nephrectomy for metastatic renal clear cell carcinoma 3 years before and had received sequential vascular endothelial growth factor receptor and mammalian target of rapamycin-targeted therapies. The abdominal computed tomography scan showed small bowel obstruction due to triple intussusception of the proximal jejunum and several large intra-luminal tumour masses. Intra-operative findings were five intramural masses 15 cm distal to the ligament of Treitz over a total length of 50 cm. A primary en bloc resection with an end-to-end anastomosis was carried out. The postoperative course was uneventful.

Metastatic disease masquerading as small intestinal tumoural masses: two case reports and literature review

“…In retrospect, the reddish and haemorrhagic appearance of these polypoid masses are in keeping with choriocarcinoma. 7 Although we have also found reports of metastatic choriocarcinoma presenting with intussusception in the jejunum, 7, 8 it is observed that masses located at the jejunum has a higher incidence of presenting as intussusception, 4–8 as compared to masses located at the duodenum which has the propensity to present as gastrointestinal bleeding. 9,10 It is useful to keep in mind that metastatic disease in the small bowel can also manifest in other forms, such as perforation, gastrointestinal bleeding and extensive polyposis.…”

“…Case reports have shown single intussusception observed for solitary polypoid mass, 4 and even multiple intussusceptions observed for multiple metastatic polypoid masses. 5,6 Primary tumours of the small intestines with clear cell features are extremely rare, with differential diagnoses including clear cell adenocarcinoma and clear cell sarcoma-like tumour of the gastrointestinal tract. When in doubt, a carefully chosen immunohistochemical panel will help to resolve the issue.…”

“…Metastatic disease presenting clinically as small intestinal tumoural masses have been described in the literature but are noted to be uncommon. [4][5][6] We hereby illustrate two such case reports of a metastatic renal cell carcinoma (RCC) and metastatic choriocarcinoma presenting as small intestinal tumoural masses. Here, we will discuss how the pathologist, armed with a healthy dose of suspicion, coupled with a careful mental evaluation of certain histological and clinical features, plus the judicious use of immunohistochemistry, can differentiate a metastatic process from a primary malignancy.…”

Metastatic Jejunal Renal Cell Carcinoma Intussusception Presenting as Melena

“…Although ultrasound is the first-line screening tool for the diagnosis of intussusception in children, it is rarely used in adults due to intestinal gas and the widespread availability of CT [ 7 ]. The best imaging modality to diagnose intussusception in adults is a CT scan [ 1 , 8 ]. Contrasted studies can assist with assessing the length of the involved segment, localization, and vascular integrity [ 1 ].…”

FDG-Avid Metastatic Non–Clear Cell Renal Cell Carcinoma Presenting as Intussusception

“…Approximately 85% of renal neoplasms are due to renal cell carcinoma 1 . Small bowel intussusception from metastatic renal cell carcinoma is very rare, 2 and several are presented in case reports, with clear cell renal cell carcinoma described when the subtype of renal cell carcinoma was noted 2–23 . Non–clear cell renal cell carcinomas represent 25% of renal cell carcinomas 24 .…”