Washington University in St. Louis School of Medicine/ Barnes Jewish Hospital St. Louis, MO
Edward F. Hurtte, MD, Surachai Amornsawadwattana, MD Washington University in St. Louis School of Medicine/ Barnes Jewish Hospital, St. Louis, MO
Introduction: Renal cell carcinoma (RCC) is known to metastasize anywhere throughout the body with the most common sites of metastasis being the lungs (71%), lymph nodes (46%), bone (36%), and liver (21 %). However, metastatic spread to the stomach is exceedingly rare. We describe a case of gastric metastasis from RCC.
Case Description/Methods: A 52-year-old female with a history of seizures, RCC with metastasis to adrenal gland and brain status post Gamma Knife and multiple lines of chemotherapy who presented with generalized weakness. There was no history of overt GI bleeding. The patient took aspirin 81 mg daily, but denied any other NSAID, antiplatelet agent, or anticoagulant use. Her initial hemoglobin was 7.1 gm/dL, decreased from her normal baseline level 1 month prior to admission. CT PE protocol that was performed 10 days prior to admission revealed interval development of multiple lung nodules, new hyperenhancing liver lesions, and an enhancing mass within the greater curvature of the stomach (figure 1). An EGD was performed and revealed multiple fungating masses in the gastric body and antrum (figure 1). Biopsies were obtained and confirmed metastatic RCC. The patient underwent palliative radiation to the stomach to control bleeding, but ultimately died six months later from complications of her metastatic disease.
Discussion: Gastric metastasis from any tumor is extremely uncommon with a reported incidence of 0.2% to 0.7% of cases. The most common malignancies presenting as metastatic solid tumors within the stomach are those arising from the breast (27%), lung (24%), esophagus (19%), and kidney (8%). In a single center database of 2,084 post-mortem patients with metastatic renal cell carcinoma, only 5 patients had gastric involvement. Patients with gastric metastases most often present with GI bleeding and anemia, with only 13% presenting with abdominal pain. In our case, the patient did not present with gastric metastases until 17 months following primary diagnosis. Treatment of gastric metastasis varies widely and includes surgical resection, endoscopic resection, chemotherapy, arterial embolization, and as in our case, radiation therapy. Generally, outcomes of patients with metastatic RCC are poor with 5-year survival rates of less than 20%.
Figure: Figure 1: Large mass in the greater curvature of gastric body on CT scan (left), large non-circumferential mass within gastric body (middle), and mucosal papule within gastric body (right).
Disclosures:
Edward Hurtte indicated no relevant financial relationships.
Surachai Amornsawadwattana indicated no relevant financial relationships.
Edward F. Hurtte, MD, Surachai Amornsawadwattana, MD. E0181 - An Unusual Cause of Iron Deficiency Anemia: Gastric Metastasis From Renal Cell Carcinoma, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.
