A CASE SERIES OF GASTRIC METASTASIS IN PATIENTS WITH A HISTORY OF RENAL CELL CARCINOMA

Document Type

Conference Proceeding

Publication Date

6-27-2024

Publication Title

J Gen Intern Med

Keywords

cabozantinib, epinephrine, hemoglobin, adult, aged, anemia, antineoplastic activity, artificial embolization, blood transfusion, cancer inhibition, case report, case study, clinical article, conference abstract, diagnosis, dizziness, drug therapy, endoscopic surgery, endoscopy, esophagus cancer, female, gastric metastasis, hematemesis, human, male, median survival time, medical history, melanoma, metastatic renal cell carcinoma, middle aged, nausea, nephrectomy, papule, renal cell carcinoma, stomach carcinoma, surgery

Abstract

CASE: Case 1 An 84-year-old male with a history of RCC (Clear cell type) with multiple metastases to bone and prostate, status post nephrectomy 5 years ago, presented with one episode of hematemesis, and dizziness. Admission lab work showed hemoglobin of 6.4. Endoscopic findings revealed a 7mm polypoid area with ulceration and active bleeding in the posterior wall of the stomach. This biopsy showed metastatic clear cell RCC, confirming the need for further consideration of gastric metastasis in RCC patients. Treatment involved blood transfusion and continuation of anticancer therapy (Cabozantinib). Case 2 An 88-year-old male, with a history of RCC (Clear cell type) with multiple metastases to bone, bladder, and lung, status post nephrectomy 2 years ago, presented with acute dizziness and nausea. Hemoglobin on presentation was 6.3. Endoscopy showed five papules with central umbilicated versus ulcerated area with one having stigmata of recent bleeding. Biopsies from the largest nonbleeding lesion were taken and were diagnosed to be metastatic renal cell carcinoma. Despite treatment with multiple different regimens, the disease progressed and also had side effects, so the patient opted for hospice care IMPACT/DISCUSSION: Renal cell carcinoma (RCC) typically metastasizes to the lungs and bones, making gastric metastasis a rare occurrence (0.2-0.7%). This case series presents two patients, with a history of RCC status post-nephrectomy, who presented with anemia. Endoscopy and biopsy confirmed metastatic gastric carcinoma, highlighting the importance of considering gastric metastasis in RCC patients. This series discusses their clinical presentation, diagnosis, and management. Gastric metastasis is infrequent, with breast, melanoma, lung, and esophageal cancers being common primary sites. RCC, the seventh most prevalent neoplasm, has an increasing incidence. Despite surgical resection, 20-50% of cases metastasize, though gastric involvement is rare (0.2%). Early detection is crucial for improved prognosis. CONCLUSION: Gastric metastasis in RCC is rare, typically occurring late in the disease course. These cases presented earlier than average, indicating aggressive progression. Gastric metastasis in RCC patients, though uncommon, demands consideration. Early detection, even with atypical symptoms, allows for better management. The literature review revealed a median survival of 6 months post-gastric metastasis. The optimal treatment is undefined. Treatment options include embolization and epinephrine injection for bleeding and endoscopic resection or surgery. Surgical resection remains the best therapeutic option for solitary gastric metastasis, resulting in significant survival prolongation in eligible patients. The presented cases emphasize the need for continued research on early detection, optimal treatments, and prognostic factors in this subset of patients.

Volume

39

First Page

S226

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