D0670 - A Rare Presentation of Small Bowel Metastasis From Renal Cell Carcinoma: A Case Report and Review

Tuesday, October 25, 2022

10:00 AM – 12:00 PM ET

Location: Crown Ballroom

Has Audio

Presenting Author(s)

Kanak Parmar, MBBS

Texas Tech University Health Sciences Center
Lubbock, Texas

Kanak Parmar, MBBS¹, Raga Dwarampudi, MD², Nicholas DCunha, MD¹
¹Texas Tech University Health Sciences Center, Lubbock, TX; ²Vyedhi Institute of Medical Sciences and Research Center, Bangalore, Karnataka, India

Introduction: At the time of diagnosis, around 25–30% of patients with renal cell carcinoma (RCC) had metastatic disease. The most common locations for metastasis of renal cancer in order of frequency include lung, bone, liver, lymph nodes and brain. RCC metastases to the small intestine are extremely rare, with limited reports in the literature.

Case Description/Methods: A 20-year-old male presented with a 3-week history of dull epigastric pain, nausea, and vomiting. Past medical history was significant for iron deficiency anemia, and metastatic RCC was diagnosed in 2021 status post right open radical nephrectomy. The biopsy showed Xp11.2 translocation associated renal cell carcinoma WHO grade 4. The patient had lost follow-up previously. His laboratory workup this admission showed persistent iron deficiency anemia with mild leukocytosis and thrombocytosis and elevated liver enzymes. CT chest/abdomen/pelvis showed concern for intussusception in the distal jejunum causing an obstruction. Surgery team was consulted who took patient for diagnostic laparoscopy. Intraoperatively intussusception was partially reduced laparoscopically but could not be completely reduced since there was a big mass acting as a lead point. The decision was then made to convert to a mini-laparotomy. Small bowel resection with primary anastomosis was performed. Pathology from the specimen confirmed metastatic RCC. Oncology was consulted who plan to start pembrolizumab plus axitinib for systemic therapy.

Discussion: RCC intraluminal metastases in the small intestine are unusual reported as 2-4% incidence. Bowel metastases from RCC can manifest in several different forms including intussusception, bowel perforation, gastrointestinal bleeding and symptoms of intestinal obstruction due to the presence of a mass within the intestinal wall. This case presented a young male with metastatic RCC to small bowel which has not been reported so far. Clinicians should be aware that, in patients presenting with anemia, clinical symptoms of bowel obstruction and a history of RCC, intestinal tumor involvement should be considered. Metastasectomy may extend patient survival and surgical resection of the involved intestinal segment has been recommended as the treatment of choice.

Figure: Figure 1: A: Axial-enhanced CT scan of the abdomen showing Intussusception in the distal jejunum causing the obstruction.
B: Intraoperative pictures of intussusception. C: A resected segment of the small intestine with a mass found at the lead point

No.	Author, Year	No. of pts	Stage of RCC(TNM)	Gender	Age(years)	Histological subtype	Outcome
1	Vani et al., 2017	2	NA	M, F	65, 68	NA	Pt. 1: Death 3 months after surgery. Pt. 2: Death 6 months after surgery.
2	Mishra et al., 2015	1	NA	M	57	Clear cell	NA
3	Wan Kyu Eo et al.,2008	1	pT1aN0M1	M	47	Clear cell	NA
4	Venugopal et al.,2017	1	NA	NA	NA	NA	NA
5	Ekbote et al., 2015	1	NA	M	52	Clear cell	Alive after ten months
6	Bellio et al.,2016	1	pT1bN0	M	75	Clear cell	NA
7	Deguchi et al., 2000	1	NA	M	58	NA	NA
8	Ogiso et al., 2005	1	pT1aN0M1	F	57	NA	NA
9	Hegde R J et al., 2014	1	NA	M	52	Clear cell	NA
10	Budmiger et al.,2015	1	NA	M	61	NA	NA
11	Kerkeni B et al.,2013	1	pT2bNxM1	F	32	Clear cell	Not interpretable
12	Khan AB et al.,1991	1	NA	NA	NA	NA	NA
13	Trojaneillo et al.,2017	1	NA	M	75	NA	Pt. died 9 months after surgery.
14	Tutar et al., 2008	1	NA	M	59	Clear cell	NA
15	Aissa et al.,2012	1	NA	M	64	Tubulo- Papillary	NA
16	Longo et al.,2013	1	NA	F	52	Clear cell	NA
17	Budmiger et al.,2015	1	NA	M	61	Clear cell	NA
18	Sasaki et al., 2006	1	NA	M	64	Clear cell	Pt died after few months after jejunal resection
19	Roviello et al., 2006	1	NA	M	48	Clear cell	Alive at follow up.
20	Rampersad et al., 2006	1	NA	F	69	NA	NA
21	Collet et al.,2001	1	NA	F	77	NA	NA
Abbreviations: NA, not applicable; F, Female; M, Male

Table: Table 1: Published reports of intussusception from renal cell carcinoma

Disclosures:

Kanak Parmar indicated no relevant financial relationships.

Raga Dwarampudi indicated no relevant financial relationships.

Nicholas DCunha indicated no relevant financial relationships.

Kanak Parmar, MBBS¹, Raga Dwarampudi, MD², Nicholas DCunha, MD¹. D0670 - A Rare Presentation of Small Bowel Metastasis From Renal Cell Carcinoma: A Case Report and Review, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.