An obscure cause of gastrointestinal bleeding: Renal cell carcinoma metastasis to the small bowel. (2015)

• Record Type: Journal Article
• Authors: Gorski, Robyn L.; Jalil, Salah Abdel; Razick, Manver; Jalil, Ala' Abdel
• Is Part Of: International journal of surgery case reports. Volume 15(2015)
• Page Start: 130
• Page End: 132
• Publication Date: 2015
• Subjects: Renal cell carcinoma -- Metastases -- Small bowel -- Bleeding -- Video capsule endoscopy -- Push enteroscopy; Surgery -- Periodicals; Surgical Procedures, Operative -- Periodicals; Surgery; Electronic journals; Periodicals; 617.005
• DOI: 10.1016/j.ijscr.2015.08.011
• Languages: English
• ISSNs: 2210-2612

Abstract

Highlights: Renal cell carcinoma metastases to the gastrointestinal tract (excluding the liver) accounts for about (0.2 − 0.7)% of RCC. RCC metastases to the gastrointestinal tract may occur years after resection of RCC. The tyrosine kinase inhibitor Sunitinib has also been shown to have survival benefits for patients with RCC metastasis. Vascular-endothelial growth factor receptor (VEGFR) as well as the mTOR-signaling pathway have been used as a treatment for RCC metastasis with good results. Use of VCE and push enteroscopy are of beneficial value in the diagnosis of obscure GI bleeding. Abstract: Renal cell carcinoma metastasis to the small intestine is a rare condition. It usually results in gastrointestinal bleeding and it could happen many years after the diagnosis with renal cell cancer. Treatment includes surgery as well as targeted agents such as tyrosine kinases. We report here the case of an 82-year-old man with a past medical history of high-grade renal cell carcinoma and right nephrectomy 6 years earlier, who presented with recurrent episodes of syncope and black stools. He underwent esophagogastroduodenoscopy (EGD) and colonoscopy without evident source of bleeding. Video capsule endoscopy (VCE) showed three bleeding lesions in the jejunum and ileum. Push enteroscopy revealed a proximal jejunum bleeding mass that was suspicious for malignancy. Histopathology demonstrated poorly differentiated carcinoma. Given the patient's history of high-grade renal cell carcinoma, and similarity of histologic changes to the old renal cell cancer specimen, metastatic renal cell carcinoma was felt to be the responsible etiology.