P1400 - Unusual Presentation of Metastatic Renal Cell Carcinomas as Upper Gastrointestinal Bleed

Srinivasan Narayanan, ¹, Pugazh Kandaswamy, MBBS, DCH, FRCPCH², Daulath Singh, MD³, Shreya Naga. Ramachandran, ⁴, Christian Clark, DO⁵, Natania Arun, ⁶, Balachandar Kathirvelu, MBBS, PhD^7
1Southampton Medical Center, Southampton, England, United Kingdom; ²Aneurin Bevan University Health Board, Newport, Wales, United Kingdom; ³Stormont Vail Health, Topeka, KS; ⁴Blue Valley North High School, Overland Park, KS; ⁵Tripler Army Medical Center, Honolulu, HI; ⁶BASIS, Phoenix, AZ; ⁷University of Texas, El Paso, El Paso, TX

Introduction: Renal cell carcinoma (RCC) is a rare form of cancer, accounting for only 3% of all adult cancers. Unfortunately, about one-third of RCC cases show signs of metastasis, with the most common affected areas being the lungs (75%), lymph nodes (36%), bone (20%), liver (18%), and brain (9%). Interestingly, metastasis to the gastrointestinal (GI) tract, specifically the colon, is quite uncommon. We herein, report a case of metastatic RCC in a patient who presented with a gastrointestinal bleed. Further examinations revealed metastatic sites in the lung and peritoneum, in addition to the GI tract.

Case Description/Methods: This is a 73-year-old male with multiple comorbidities who was admitted to the hospital due to symptomatic anemia, with a Hemoglobin level of 5.0 g/dl. It was later discovered that he had a GI bleed, and he received blood transfusions for support. Further investigation through Esophagogastroduodenoscopy (EGD) and Colonoscopy revealed polyps in his stomach, duodenum, colon, and rectum. A biopsy of the stomach and duodenal polyp confirmed metastatic clear cell carcinoma. A Positive Emission Tomography (PET CT) showed extensive metastasis, including a necrotic mass of 12 cm in the right kidney, a 6 cm left renal lesion, multiple hypermetabolic pulmonary nodules with left pleural metastasis, a dominant left upper lung mass of 5 cm, mediastinal and hilar lymph nodes, hypermetabolic activity in the gastroduodenal junction, and multiple soft tissue nodules in the left gluteus, right upper arm, and left axillary region. Due to concerns about a second primary, he had a biopsy of the lung mass, which confirmed metastatic renal cancer. Unfortunately, due to his multiple comorbidities and rapidly declining performance status, he was not considered a candidate for any therapy. Therefore, he chose to receive comfort/hospice care.

Discussion: Metastases in RCC rarely occur in the gastrointestinal tract, accounting for less than 4% of cases. While it is uncommon, RCC can metastasize to various parts of the gastrointestinal tract without a clear explanation of the pathway. The sigmoid, splenic flexure, transverse colon, and hepatic flexure are commonly affected sites. Unfortunately, the prognosis for metastatic patients who do not undergo surgery is typically unfavorable.






Disclosures:


Srinivasan Narayanan, ¹, Pugazh Kandaswamy, MBBS, DCH, FRCPCH², Daulath Singh, MD³, Shreya Naga. Ramachandran, ⁴, Christian Clark, DO⁵, Natania Arun, ⁶, Balachandar Kathirvelu, MBBS, PhD⁷. P1400 - Unusual Presentation of Metastatic Renal Cell Carcinomas as Upper Gastrointestinal Bleed, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.