University of Minnesota Minneapolis, MN, United States
Mandip KC, MD1, Mohammad Bilal, MD2 1University of Minnesota, Minneapolis, MN; 2Minneapolis VA Health Care System, Minneapolis, MN
Introduction: Patients with renal cell carcinoma are metastatic in 1/3rd of the cases, however, metastasis to gastrointestinal tract is uncommon. We present a case of rare finding of metastatic renal cell carcinoma presenting as gastric polyp in a patient who presented with gastrointestinal bleeding.
Case Description/Methods: A 70-year-old man with history of clear cell renal cell carcinoma (ccRCC) with metastatic mediastinal lymphadenopathy presented with melena and anemia. The patient had received Nivolumab and Ipilimumab in the past and was currently on Cabozatinib for the past fourteen months. Patient denied any use of non-steroidal anti-inflammatory drugs. Laboratory data was significant for a hemoglobin of 6.8 g/dL. An esophagogastroduodenoscopy showed two friable gastric polyps ranging from 8-10 mm in the body. Polyps were removed using a cold snare and endoclips were placed. Histopathological analysis demonstrated portions of gastric mucosa with central area of fibrinoid necrosis covering clusters of epithelial cells with pale to clear cytoplasm, with immunostains Pax2/8 consistent with metastatic renal cell carcinoma.
Discussion: Metastasis of RCC to stomach presenting as gastric polyps is exceedingly rare. The gross appearance of these polyps appears to have a smooth surface and can be friable to contact. The size of the polyp can be variable. Clinical presentation includes gastrointestinal bleeding and abdominal pain as was the case in our patient. Small gastric polyps are often not biopsied, however, our case highlights that in patients with RCC, gastric polyps should be biopsied to rule out metastasis.
Figure: Images showing gastric polyp, with pathology showing clear cell RCC on H&E and Pax2/8 stain.
Disclosures:
Mandip KC indicated no relevant financial relationships.
Mohammad Bilal indicated no relevant financial relationships.
Mandip KC, MD1, Mohammad Bilal, MD2. P2060 - Metastatic Renal Cell Carcinoma Presenting as a Gastric Polyp – A Case Report, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.
