E0733 - Late Metastatic Renal Cell Carcinoma Diagnosed by Abdominal Pain and Endoscopy: A Case Report

Tuesday, October 25, 2022

3:00 PM – 5:00 PM ET

Location: Crown Ballroom

Has Audio

Presenting Author(s)

Jahnavi Udaikumar, MD

NYU Langone
Brooklyn, NY

Jahnavi Udaikumar, MD, Mahesh Krishnaiah, MD, Sam Serouya, MD
NYU Langone, Brooklyn, NY

Introduction: Metastases to the stomach from various primary malignancies is rare. Renal cell carcinoma (RCC) metastasis to the stomach is even more uncommon and should be suspected in patients complaining of the slightest of gastrointestinal symptoms. Here, we explore a rare case of gastric metastases from RCC, eleven years after radical nephrectomy diagnosed by endoscopy.

Case Description/Methods: We report the case of a 71-year-old Hispanic female, medical history pertinent for RCC and left nephrectomy, who presented with persistent left lower quadrant abdominal pain and normal bloodwork. Repeat imaging reveals a gastric mass, unseen on CT scans 3 weeks prior (Figure 1a). Endoscopy (Figure 1b), histopathological findings, and immunohistochemical staining (Figure 1c) were consistent with metastatic RCC. Given the poor prognosis, patient chose to undergo targeted systemic chemotherapy.

Discussion: In the past two decades, there have been a limited number of case reports in the literature of RCC metastatic to the stomach (Table 1). Although gastric metastasis is a late finding in the course of renal malignancy, detection can come from a thorough evaluation of presenting symptoms followed by appropriate diagnostic imaging. Additionally, this case also emphasizes the need for targeted treatment modalities for patients with poor prognoses.

Figure: Figure 1a. Abdominal and pelvic CT revealing of mass in the stomach; Figure 1b. Upper endoscopy revealing ulcerated, friable mass in the gastric antrum; Figure 1c. Histopathological staining of renal cell carcinoma (RCC) metastasis to gastric antrum

AGE/GENDER	PRESENTING SYMPTOMS	INTERVAL (YEARS)	DIAGNOSTIC IMAGING MODALITY	PROGNOSIS	TREATMENT	OUTCOME
60/M	melena	20			endoscopic ablation
78/M	anemia	4			total gastrectomy	died at 5 months
61/F	melena, anemia, epigastric pain	4		3b/0/0	none	alive with disease at 6 months
69/F	UGI bleeding, melena	3			palliative embolization	died at 23 months
68/M	UGI bleeding, melena	11	CT, CXR		chemotherapy (sunitinib)	died at 2 years
67/F	melena, dyspnea	5	CT	3a/X/X	total gastrectomy
	melena, anemia	10			wedge resection	no tumor recurrence at 18 months
78/M	anemia	5			endoscopic mucosal resection	died at 6 months after surgery
69/M	epigastric pain, nausea, emesis	4.2		2/X/X	chemotherapy (tamoxifen)	died at 19 months
77/M	none	6.3		3a/X/X	radiation (interferon)	died at 4 months
83/F	melena, anemia	1.7		3b/X/X	endoscopic ablation	died at 5 months
65/F	UGI bleeding, melena, anemia	13.1		3a/X/X	endoscopic ablation	died at 3 months
69/M	anemia, epigastric pain	9.3		3a/X/X	endoscopic ablation, chemotherapy (sunitinib)	alive with disease at 2 years
71/M	abdominal pain	0			none	alive with disease
53/M	melena, dizziness	0			none	died at 2 months after diagnosis
74/M	melena	5	upper endoscopy	3b/0/0	wedge resection	died 4 weeks after surgery
49/M	none	2	upper endoscopy	3a/0/1	partial gastrectomy	died 15 months after surgery
69/M	melena	19	upper endoscopy	1/0/0	wedge resection	no tumor recurrence at 12 months
75/M	none	3	CT	3/0/0	chemotherapy (sunitinib)	no tumor recurrence at 6 months
59/F	none	1.5	CT	1b/0/0	chemotherapy (sunitinib)	alive with disease
65/M	melena	9		3a/X/X	polypectomy	alive with disease at 7 years
79/M	abdominal pain	0	upper endoscopy	1b/0/1	endoscopic submucosal resection	no tumor recurrence at 6 months
67/M	none	6	CT	3a/0/0	chemotherapy (sorafenib tosylate)	no tumor recurrence at 20 months
70/M	epigastric pain	6	upper endoscopy	1a/0/0	partial gastrectomy	no tumor recurrence at 14 months
61/M	UGI bleeding, melena, anemia	1.5	upper endoscopy		partial gastrectomy	died 4 months after surgery
61/M	none	8	CT		wedge resection	no tumor recurrence after 2 years
64/M	none	12	upper endoscopy		endoscopic submucosal dissection	no tumor recurrence after 23 years
80/M		20
79/M	none	0	CT	1a/0/0	endoscopic mucosal resection	no tumor recurrence at 6 months
71/F	melena, anemia		upper endoscopy		palliative embolization
71/F	abdominal pain	11	CT, upper endoscopy	3a/X/X	chemotherapy (sunitinib)	alive with disease

Table: Table 1: Literature review of renal cell carcinoma (RCC) metastases to the stomach from 2002 to 2022; Key: M – male, F – female, UGI - upper gastrointestinal, CT – Computerized tomography, CXR – chest x-ray

Disclosures:

Jahnavi Udaikumar indicated no relevant financial relationships.

Mahesh Krishnaiah indicated no relevant financial relationships.

Sam Serouya: Ambu – Consultant.

Jahnavi Udaikumar, MD, Mahesh Krishnaiah, MD, Sam Serouya, MD. E0733 - Late Metastatic Renal Cell Carcinoma Diagnosed by Abdominal Pain and Endoscopy: A Case Report, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.