Isolated gastric metastasis from renal cell carcinoma 19 years after radical nephrectomy

Gastric Metastasis of Renal Cell Carcinoma Initially Diagnosed by Esophagogastroduodenoscopy

Here, we report a rare case of renal cell carcinoma (RCC) initially detected as a gastric metastasis. A 58-year-old man with epigastric discomfort underwent esophagogastroduodenoscopy, which revealed a reddish semi-pedunculated lesion with a whitish coating. Biopsy and imaging confirmed clear cell RCC metastasis. Contrast-enhanced computed tomography (CT) revealed a primary renal tumor with pancreatic and lymph node metastases. Despite chemotherapy treatment, the patient died after 10 months. Gastric metastases from RCC, although rare, should be considered in highly vascular gastric lesions with white coatings. Clinicians must be vigilant for metastatic diseases with atypical gastric findings.

Hybrid Endoscopic Submucosal Dissection for Isolated Gastric Metastasis of Renal Cell Carcinoma

Metastasis to the stomach is a rare occurrence, especially from renal cell carcinoma (RCC). We report a case of a 76-year-old man with a history of RCC, in remission for 11 years postnephrectomy, who presented with gastrointestinal symptoms, was found to have a 2 cm gastric mass confirmed as metastatic RCC. Endoscopic submucosal dissection was attempted, but due to the hypervascular nature of the mass, a hybrid endoscopic submucosal dissection was performed, achieving complete resection. Follow-up at 7 months showed no recurrence, highlighting the potential for endoscopic treatment options for isolated gastric metastasis, despite the lack of specific guidelines.

Gastric metastasis from renal cell carcinoma with submucosal invasion treated by surgical full-thickness resection: a case report

BACKGROUND

Metastatic gastric tumors are rare and malignant melanoma, breast cancer, lung cancer, and esophageal cancer are common as primary lesions. On the other hand, renal cell carcinoma is easy to metastasize hematogenously to the whole body. However, metastasis to the stomach is rare and the detailed treatment of gastric metastasis is not mentioned. In this study, we report an uncommon case of gastric metastasis from renal cell carcinoma that underwent surgical full-thickness resection and reviewed the literature for treatment options.

CASE PRESENTATION

The patient was a female in her 60s and in January 2007, she underwent a transabdominal left nephrectomy for clear cell carcinoma of the left kidney. The pathological diagnosis was pT2N0M0 stage II. In October 2017, a total pancreatectomy with D2 dissection was performed for multiple pancreatic masses, in which the pathological diagnosis was pancreatic metastasis of renal cell cancer. In May 2019, an esophagogastroduodenoscopy for heartburn revealed redness and erosion in the greater curvature of the residual gastric body. The pathological diagnosis was gastric metastasis from renal cell carcinoma. No metastatic findings were observed and gastric wedge resection was performed. Pathological diagnosis of the resected specimen showed a 4-mm tumor, mainly within the mucosa and partly extended to the submucosal layer in 500 µm. The resected specimen had a clear resection margin.

CONCLUSIONS

In this study, we report a case in which a full-thickness resection was performed for gastric metastasis 12 years after renal cancer surgery and 2 years after pancreatic metastasis surgery. The patient survived 4 years and 8 months after gastric wedge resection. Although gastric metastasis often takes the form of submucosal tumors, it is necessary to select full-thickness resection for R0 resection, even in small and flat lesions.

Case report: Endoscopic full-thickness resection of gastric metastatic tumor from renal cell carcinoma

Renal cell carcinoma (RCC) is a common malignant kidney tumor; however, gastric metastasis is rare. We report the case of an 82-year-old male patient who developed gastric metastasis 12 years after an initial diagnosis of RCC. The patient underwent endoscopic full-thickness resection (EFTR), and the gastric metastatic focus was successfully removed. Postoperative pathology and immunohistochemistry showed that the gastric metastasis originated from RCC. Although gastric metastasis of RCC is rare, it should be suspected in patients with a history of RCC or gastrointestinal symptoms. EFTR is associated with reduced trauma and greater retention of gastric tissue and function. It is a more appropriate choice than surgical resection; however, it requires more endoscopists.

Gastric metastasis presenting as submucosa tumors from renal cell carcinoma: A case report

BACKGROUND

Gastric metastasis from renal cell carcinoma (RCC) is an extremely rare clinical entity. Due to an easily neglected RCC history, nonspecific symptoms and under-recognized endoscopic presentation may lead to a potential diagnostic pitfall in daily clinical practice.

CASE SUMMARY

We present a case of metastatic gastric tumors arising from RCC 5 years after radical nephrectomy. Simultaneous, multifocal metastases to the gallbladder, pancreas and soft tissue were observed. One year previously, a solitary submucosal discoid tumor with a central depression was detected in the gastric fundus in a 65-year-old man. Endoscopic ultrasonography (EUS) showed a 1.12 x 0.38 cm lesion originating from the deeper mucosal layers with partially discontinuous submucosa. One year later, the endoscopic findings of the lesion showed various changes. A large lesion of the protruding type (2.5 cm × 2 cm) was found in the fundus at the same location. EUS showed a heterogeneous mass that involved the mucosa and submucosal layer. In addition, two small similar submucosal lesions 0.4-0.6 cm in size were detected. These lesions had a central depression, surface mucosal congestion and thickened vessels. The two adjacent lesions in the fundus were resected by endoscopic submucosal dissection. Based on the postoperative pathological analysis, the patient was diagnosed with gastric metastasis from RCC.

CONCLUSION

Gastric metastasis from RCC should be considered in patients with a history of RCC irrespective of the time interval involved.

Application of 18F Prostate-Specific Membrane Antigen Positron Emission Tomography/Computed Tomography in Monitoring Gastric Metastasis and Cancer Thrombi from Renal Cell Carcinoma

Background. Renal cell carcinoma (RCC) with gastric metastasis is rare, particularly accompanied by multiple cancer thrombi. Methods. We reported a 66-year-old man with a history of a right radical nephrectomy because of RCC. The patient underwent 18F prostate-specific membrane antigen (PSMA) positron emission tomography/computed tomography (PET/CT) scanning after 6 months of targeted therapy because of gastric metastasis and cancer thrombi. We conducted a systematic review of the literature and identified 73 cases of RCC with gastric metastasis. We analyzed the clinicopathological characteristics, therapies, and outcomes of patients. Results. 18F-PSMA PET/CT showed a large mass in the gastric fundus and cancer thrombi in the right atrium, inferior vena cava, and splenic vein with intense tracer uptake. Other metastases with increased tracer uptake included multiple bones and abdominal lymph nodes. The majority of gastric metastasis of RCC were men (53/73, 72.6%), with a median age at presentation of 67 (from 48 to 87) years. Gastric metastasis of RCC was mainly metachronous, and presented with small polyps or mass appearance and often accompanied by multiple-site metastases and gastrointestinal symptoms. An overall median interval between nephrectomy and diagnosis of gastric metastasis was 6 (from 0.1 to 23) years, and an overall median survival time was 14 (from 0.25 to 72) months. The median interval time of solitary gastric metastasis was longer than gastric metastasis with multiple-site metastases (7 vs.5 years; $P=0.034$ ). Patients with gastric and multiple-site metastases had higher mortality than patients with solitary metastasis (17 vs.1; $P=0.028$ ). The patients with synchronous gastric metastasis had a shorter survival time than metachronous gastric metastasis (6 vs.17 months; $P=0.018$ ). Conclusions. Postoperative follow-up of multiple imaging modalities to monitor recurrence and metastasis is necessary and important. PSMA PET/CT can improve the detection sensitivity of RCC, especially in metastatic clear cell renal cell carcinoma (ccRCC), and could provide a basis for disease staging, restaging, and therapeutic efficacy evaluation.

Are gastric metastases of renal cell carcinoma really rare? A case report and systematic review of the literature

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Solitary gastric metastasis of RCC are scarce.

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When feasible, surgical or endoscopic treatment of gastric metastasis should be performed.

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Risk of metastatic recurrence is significant and must be taken into consideration in the therapeutic strategy.

Introduction

Renal cell carcinoma (RCC) represents above 3 % of all cancers. At diagnosis, above 25 % of patients with RCC present an advanced disease. Gastric metastasis of RCC is associated with poor outcome. We report the case of a patient treated for a gastric metastasis of RCC and we conducted a systematic review of the literature to report all published cases of RCC patients with gastric metastasis.

Case presentation

In December 2010, a 61-year-old man was treated by open partial nephrectomy for a localized right clear cell RCC. In September 2018, a metachronous gastric metastasis was found on CT scan. The lesion was located on the lesser curvature of the stomach, measuring 4.5 cm long axis. No other secondary lesions were identified. A laparoscopic wedge resection, converted to laparotomy was performed. Two years later, in September 2020, a CT scan was performed, revealing a 17 mm adenopathy behind the hepatic hilum and a surgical management was performed, including a lymph node dissection of the hepatic hilum and the hepatic artery. Actually, he remains healthy.

Clinical discussion and conclusion

Our systematic review suggests that solitary gastric metastasis of RCC are scarce. In comparison of patients with multiple metastatic sites, the median survival of patients with solitary gastric metastasis is longer.

Gastrointestinal Metastases From Primary Renal Cell Cancer: A Single Center Review

Introduction: Digestive metastases (DMs) from renal cell cancer (RCC) are rare. Over the past decade, the overall survival of metastatic RCC (mRCC) has been improved by tyrosine kinase inhibitors (TKIs) and immune checkpoint inhibitors. The main objective of this study was to assess the incidence of metastases of the digestive tract in this new field of treatment. The secondary objectives were to evaluate the clinical characteristics, prognosis, treatments used for DMs, and median time between the diagnosis of RCC or mRCC and DMs. Materials and Methods: A retrospective analysis of data collected from all patients with mRCC between 2007 (the time of TKI was a standard of care) and 2019 was carried out at the Paoli-Calmettes Institute (Marseille, France). Computer research software using artificial intelligence (ConSoRe®) was used to identify patients and assess their characteristics. Results: Between January 2007 and December 2019, 11 out of 660 (1.6%) mRCC patients had metastases of the gastrointestinal tract. The median age was 62 years. Of the 11 patients, 81.8% experienced digestive bleeding or anemia. Only 2 patients were asymptomatic. The metastases were mainly duodenal (50%) and gastric (41.6%). The median time from cancer diagnosis and from metastatic disease to gastrointestinal metastasis was 4.3 years (3 months-19.2 years) and 2.25 years (0 days-10.2 years), respectively. Local treatment was performed in 38.5% of cases by endoscopy (60%), surgery (20%) and radiotherapy (40%) with success rates of 33, 100, and 50%, respectively. Etiological treatment was modified following the discovery of DM in 84.6% of the cases. The median survival was 1 year from the diagnosis of DM (13 days-9.4 years). Two patients were still alive 2.9 and 9.4 years after the diagnosis of DM. Conclusion: This is the largest monocentric retrospective analysis of DM in patients with RCC. It seems to be a rare and late event in the course of the disease. Local treatment combined with systemic treatment could improve survival. In the context of prolonged survival with the new based immunotherapy treatments in mRCC, we suggest that unexplained anemia or persistent digestive symptoms could be explored by endoscopy.

Simultaneous resection of gastric and gallbladder metastasis from renal cell carcinoma treated by laparoscopic and endoscopic cooperative surgery: a case report

Background

Metastases to the stomach or gallbladder from any malignancy is rarely noted, and simultaneous metastases to both organs are atypical. We present a unique case of simultaneous multifocal metastases of the stomach and gallbladder from renal cell carcinoma (RCC).

Case presentation

The case involved a 60-year-old man, with a past history of RCC (clear cell type, G2, T1b N0 M0 Stage I) treated by a right nephrectomy. Three years after the nephrectomy, a routine gastrointestinal endoscopy found an ulcerative lesion in the greater curvature of the gastric body. The gastric tumor was pathologically proven to be a metastasis from RCC. Furthermore, computed tomography incidentally revealed a mass lesion in the fundus of the gallbladder, which was also diagnosed as a potential metastasis from RCC. As endoscopic ultrasonography of the gastric tumor suggested the tumor potentially invaded to the submucosal layer, gastric wedge resection via a laparoscopic and endoscopic cooperative surgery (LECS) technique was applied to the gastric tumor, and laparoscopic cholecystectomy to the gallbladder tumor was simultaneously performed. Histological examination confirmed that the tumors of the stomach and gallbladder were both metastatic RCC. The hospitalization period after surgery was not eventful, and the patient was discharged on postoperative day 7. Thereafter, the patient required examination every 3 months, did not use anticancer agents, and has survived without relapse to 9 months after the surgery.

Conclusions

For patients with locally resectable RCC metastases, complete metastasectomy may bring long-term tumor control. Moreover, LECS for gastric metastasis is a reasonable approach for minimal invasiveness and an oncologically feasible outcome.

Metastatic Renal Cell Carcinoma as Solitary Subcentimeter Polypoid Gastric Mucosal Lesions: Clinicopathologic Analysis of Five Cases

Background

The stomach is an uncommon site for metastatic carcinoma. Approximately 6% of renal cell carcinomas (RCCs) may metastasize to the stomach. The majority of the reported metastatic RCCs in the stomach presented as large masses or ulcers greater than a centimeter in size. It is very rare to encounter metastatic RCC as a solitary small polypoid gastric mucosal lesion.

Methods

In this study, we collected surgical pathology cases of gastric metastasis from RCC that measured 1.0 cm or less at the time of endoscopy. The clinicopathological characteristics were analyzed.

Results

Five patients with subcentimeter metastatic RCC involving the gastric mucosa were identified. The clinical presentation for upper endoscopic examination was non-specific. Two of the five patients did not have a known history of RCC. In the three patients with a previous history of RCC, the interval from primary RCC diagnosis to the detection of gastric mucosal metastasis was 5, 6, and 10 years, respectively. Endoscopically, all the lesions were solitary, ranging in size from 0.4 to 1 cm. Histologically, all five cases were of the clear cell type consisting of a bland clear cell proliferation within the lamina propria. Although the tumor cells were relatively bland, the presence of clear cytoplasm, nuclear membrane irregularity, occasional enlarged hyperchromatic atypical nuclei, and destructive growth in the center of the lesion should promote immunohistochemical workup. Immunohistochemically, the RCC cells exhibited at least patchy immunoreactivity for cytokeratin and RCC markers. In two cases, there were many CD68 positive foamy histiocytes intermingled with the tumor cells.

Conclusion

Metastatic RCC can rarely present as subcentimeter polypoid gastric mucosal lesions. The remote or unknown history of RCC, the non-specific endoscopic appearance, and the bland histological features may lead to a potential diagnostic pitfall. It is of importance to raise the awareness of such an unusual presentation of metastatic RCC in the stomach and to include metastatic RCC in the differential diagnosis for gastric mucosal polyps with clear cell morphology.

Gastric Metastasis from Renal Cell Carcinoma, Clear Cell Type, Presenting with Gastrointestinal Bleeding

Renal cell carcinoma (RCC) accounts for 80-85% of all primary renal neoplasms. Although RCC can metastasize to any organ, gastric metastases from RCC are exceedingly rare. A 67-year-old male presented with melena and acute blood loss anemia. The patient had a history of RCC that had been treated with a radical nephrectomy. He had a recent myocardial infarction and was receiving double antiplatelet therapy. After hemodynamic stabilization, esophagogastroduodenoscopy showed a polypoid mass in the gastric fundus. The mass was excised. Histological and immunohistochemical evaluation were consistent with clear cell RCC. The polypoid lesion is consistent with a late solitary metastasis.

Palliative Surgery for Advanced Cancer: Identifying Evidence-Based Criteria for Patient Selection: Case Report and Review of Literature

BACKGROUND

Criteria for selecting patients with advanced cancer for palliative surgery (PS) remains poorly defined. Decision making for PS requires realistic treatment goals with well-defined criteria. Here we discuss a 71-year-old Jehovah's Witness with advanced stage renal cell carcinoma (RCC) who presented with profound anemia due to intractable bleeding from gastric metastasis. After repeated attempts with endoscopic and angiographic management, she underwent surgical palliation. Through this case, we developed 10-item evidence-based criteria for selecting patients for PS.

OBJECTIVE

The study objective was to provide a review of pertinent literature for PS and identify evidence-based criteria for patient selection. These criteria were relevant for selecting this patient with metastatic RCC and may prove beneficial for selecting advanced cancer patients for PS.

METHODS

A MEDLINE search revealed 175 publications relevant to PS. Among these, 17 articles defining patient selection criteria (PSC) were reviewed. A frequency-based analysis of each criterion was performed. Another search returned 30 cases of RCC gastric metastases from 25 published reports. Outcome analysis was determined by the Kaplan-Meier actuarial method.

RESULTS

Ten criteria were identified: symptom control, prognosis, preoperative performance status, quality of life (QoL), tumor burden amenable to palliation, procedure-related morbidity and mortality, feasibility of nonsurgical therapies, anticipated hospitalization, requirement for additional palliation, and cost. This patient met all inclusion criteria and underwent a successful gastrectomy. Median survival for patients with RCC gastric metastasis was 20 months.

CONCLUSIONS

This report illustrates an example of implementation of evidence-based criteria for selecting advanced cancer patients for PS. Validation of these criteria is warranted.

Gastric metastasis from renal cell carcinoma with gastrointestinal bleeding: a case report and review of the literature

A 61-year-old man presented to our hospital with hypercalcemia and elevated C reactive protein (CRP). Evaluation revealed renal cell carcinoma (RCC) with metastasis to lung, bone, and brain. He underwent partial resection of the right kidney and a left nephrectomy. Histopathologic findings of resected tumors were consistent with clear cell RCC. Whole-brain irradiation was performed for management of brain metastasis. Postoperatively, he was treated with molecularly targeted therapy using a mammalian target of rapamycin inhibitor. Approximately 14 months later, he suffered an episode of upper gastrointestinal bleeding with secondary anemia and melena. Upper gastrointestinal endoscopy revealed a distinctly protruding lesion in the gastric body. Biopsy of the gastric lesion showed metastatic clear cell RCC. He underwent partial gastrectomy. His postoperative course was uneventful. However, 4 months after surgery, he died from brain metastasis. Metastatic RCC to the stomach, although rare, should be suspected in any patient with a history of RCC who presents with gastrointestinal symptoms.

Metastatic gastric tumors arising from renal cell carcinoma: Clinical characteristics and outcomes of this uncommon disease

We analyzed the clinicopathological characteristics and therapeutic outcomes of patients with metastatic gastric tumors arising from renal cell carcinoma (RCC) to identify post-therapy prognostic factors. A total of 22 patients who were treated for metastatic gastric tumors arising from RCC were included in the study. A retrospective review was performed on the clinical characteristics of this disease. The median time interval from radical excision of the primary tumor to the detection of gastric metastasis (IGM) was 6.3 years. The overall 1- and 3-year survival rates were 52.6 and 21.0%, respectively, and the median survival time was 19 months. Compared with patients with an IGM of <6.3 years, patients with an IGM of ≥6.3 years showed a significantly longer median survival time (5 vs. 24 months; P=0.017). The median tumor size was significantly greater in patients with multiple metastases compared with those with solitary metastasis (4 vs. 2 cm; P=0.036). The incidence of patients who had undergone therapeutic tumor resection was significantly higher in patients with solitary metastasis compared with those with multiple metastases (100.0 vs. 35.7%; P=0.019). The appearance of gastric tumors in patients with a history of RCC should prompt the clinician to investigate the possibility of metastasis even several years after detection of the original renal cancer. A longer interval from nephrectomy to the diagnosis of gastric metastasis is generally indicative of a better prognosis, most likely the result of less aggressive tumor growth.

Metastatic renal cell carcinoma presenting as gastric polyps: A case report and review of the literature

INTRODUCTION

Renal cell carcinoma (RCC) accounts for approximately 3% of adult malignancies and is responsible for over 13,000 deaths in the U.S. annually. The fatalities are largely due to distant metastasis, with lung, liver, bone and brain being most commonly affected organs. Gastric metastasis from RCC is a rare event (less than 20 cases reported in the English language literature) and usually presents as a large, solitary mass or ulcer (average size of 4.8cm) resembling primary gastric cancer. Here we report the first case of metastatic RCC presenting as small gastric polyps.

PRESENTATION OF CASE

The patient was a 60-year-old African American woman with a history of clear cell RCC (pT1bNX). She underwent esophagogastroduodenoscopy and colonoscopy 5months after nephrectomy due to anemia. Two non-ulcerated, 0.6-cm benign-appearing polyps were found at the greater curvature of the gastric body, which were subsequently removed endoscopically. Unexpectedly, histopathologic examination of the gastric polyps revealed nested collections of vacuolated epithelioid cells in a background of delicate, arborizing vasculature, immediately beneath the congested and hyperplastic foveolar epithelium. A diagnosis of metastatic RCC was rendered after confirming the renal epithelial origin by immunohistochemical stains.

DISCUSSION

Gastric metastasis from RCC usually presents as a large, solitary mass or ulcer, but it can be subtle and present as multiple, small benign-appearing polyps.

CONCLUSION

A careful follow up and thorough endoscopic and histopathologic examinations should be conducted in patients with a history of RCC who present with gastrointestinal manifestations.

Solitary synchronous metastatic gastric cancer arising from t1b renal cell carcinoma: a case report and systematic review

Metastasis to the stomach from renal cell carcinoma (RCC) is extremely rare. Usually, gastric metastasis seems to be a late event in patients with RCC and is accompanied by disseminated tumor spread to other organs. Solitary synchronous gastric metastasis from small, localized RCC has rarely been reported. We report a case of 79-year-old man with synchronous gastric metastasis presenting with a single erosive lesion from pT1 RCC. The patient underwent radical nephrectomy and endoscopic resection for metastatic gastric cancer. The resected specimen showed an ill-defined tumor, approximately 0.6 cm long, with a clear resection margin. The morphologic features of the tumor cells were consistent with those of metastatic RCC of the clear cell type. At 6 months's follow-up, the patient did not show local recurrence or additional metastasis on upper endoscopy and computed tomography scan.

XPA-210: a new proliferation marker to characterize tumor biology and progression of renal cell carcinoma

PURPOSE

Recent lung cancer data have shown an association of XPA-210, a key peptide of thymidine kinase, with advanced disease. We thus assessed its proliferation status in primary (M0) and metastatic (M1) renal cell carcinoma (RCC).

METHODS

Paraffin slides from 30 patients (mean age: 61.2 years; range: 42-84) with clear-cell RCC (M0 in 10; non-osseous M1 in 10; osseous M1 in 10) were T-matched for pT1/pT3. Corresponding malignant and benign renal parenchyma were immunohistochemically stained against XPA-210. Staining density was determined by a semi-quantitative score of positive cell shares. Staining intensity included the precise cellular location.

RESULTS

XPA-210 occurred predominantly in the nucleus, with a minor cytoplasmatic component. RCC tissue showed higher density and stronger intensity than did benign renal tissue in both nucleus (P = 0.005) and cytoplasm (P = 0.01). Density and intensity were positively associated with tumor diameters ≤7 cm, whereas they tended to correlate inversely in tumors >7 cm (P 0.07). Density of stained cells was significantly higher in metastatic than in localized RCC in both nucleus and cytoplasm (P < 0.04). Non-osseous M1 tissue showed significantly higher nuclear and cytoplasmatic expression than did M0 tissue (P < 0.05), whereas osseous M1 tissue did not.

CONCLUSIONS

In all RCC tissues, XPA-210 staining was significantly higher in the nucleus than in cytoplasm, potentially owing to large cytoplasmatic spaces as a characteristic histologic feature of clear-cell component. XPA-210 expression gradually increased from localized to metastatic disease, peaking in patients without bone involvement. Therefore, XPA-210 might aid the selection of appropriate adjuvant treatment in high-risk patients.