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      Endoscopic Mucosal Resection of a Large Gastric Metastasis from Renal Cell Carcinoma

      case-report
      Author(s): , MD 1 , , MD 2 , , MD 1 ,
      Publication date (Electronic):
      Journal: ACG Case Reports Journal
      Publisher: American College of Gastroenterology

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          Abstract

          Gastric metastasis from renal cell carcinoma (RCC) occurs in less than 1% of cases. A variety of management options have been described for this condition, however, total or partial gastrecomy is the most common therapeutic approach. We present a case of a large gastric metastatic lesion from a RCC diagnosed 10 years before. This was treated with endoscopic mucosal resection (EMR) without evidence of residual lesion after 10 months of follow-up.

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          The evolving presentation of renal carcinoma in the United States: trends from the Surveillance, Epidemiology, and End Results program.

          Mike Nguyen, Inderbir Gill, Lars Ellison (2006)
          The incidence of renal cancer is increasing, while cases series suggest that tumor size is decreasing. This has important implications for treatment planning. We evaluated national trends in renal cancer size and observed survival in patients diagnosed in the 3 periods 1988 to 1992, 1993 to 1997 and 1998 to 2002. From the Surveillance, Epidemiology, and End Results database we identified 29,053 patients diagnosed with primary renal cancer. Patients were stratified into size categories and 5-year time cohorts. Size distribution was compared across cohorts. Kaplan-Meier survival curves and Cox proportional hazards modeling were used to examine trends in overall and stage specific survival. From 1988 through 2002 renal tumor size decreased from 66.8 to 58.6 mm, while the age adjusted incidence of renal cancer increased from 8.6 to 11.2 cases per 100,000 individuals. Kaplan-Meier analysis showed steadily deteriorating survival with increased cancer size above 4 cm with a median survival of 105 months for 4 to 7 cm vs 46 months for more than 7 cm. Cox modeling demonstrated significantly improved survival in patients diagnosed in the latter cohorts. With adjustment for size the latter cohorts remained significantly improved compared to the earliest cohort, although the 1998 to 2002 cohort was no longer significantly different than the 1993 to 1997 cohort. Nationally renal tumor size at presentation has steadily and consistently decreased. Patients more recently diagnosed had improved survival, which could be attributable to decreased tumor size in the latter cohorts. Patients more recently diagnosed also demonstrated a relative survival advantage independent of size compared to the earliest patients studied.
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            Clinical diagnosis of metastatic gastric tumors: clinicopathologic findings and prognosis of nine patients in a single cancer center.

            Osamu Kobayashi, Hisahiko Motohashi, Takaki Yoshikawa … (2004)
            The clinical features of metastatic gastric tumors (MGTs) have not been well documented. We present a clinical series of nine patients with MGTs. Among 2579 patients with gastric tumors seen between 1992 and 2001, we studied 9 (0.3%) patients with MGT according to a prospective database. The MGTs were diagnosed based on findings in the surgical or endoscopic specimen, and patients with malignant lymphoma or direct invasion from adjacent organs were excluded from the study. MGTs were detected simultaneously with the primary tumors in three and afterward in six patients at 14 to 74 months. The primary tumors included one each of squamous cell carcinoma of the esophagus, signet-ring cell carcinoma of the breast, large-cell or small-cell carcinoma of the lung, renal cell carcinoma, hepatocellular carcinoma, squamous cell or epidermoid carcinoma of the uterus, and melanoma. Multiple organ metastases were present simultaneously in six patients. Although six patients underwent gastrectomy, macroscopic eradication of gastric metastatic disease was accomplished in only four, in whom a UICC R0 resection was possible in only two. Five patients were treated by chemotherapy with no apparent survival benefit. A median survival after MGT diagnosis was 170 days (range 16-892 days) for all cases, 384 days for those who underwent gastrectomy (n = 6), and 27 days for those without active treatment (n = 3) (p = 0.002). The cause of death was multiple organ metastases in most cases. Because multiple metastases are common, the prognosis of MGT is poor even after curative resection. MGT is likely to be a preterminal event, and surgical resection may be useful only for palliation.
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              Renal cell carcinoma metastatic to the stomach: single-centre experience and literature review.

              A Schlemmer, J. Pollheimer, Cord Langner … (2008)
              To investigate the incidence, clinical presentation and therapy of gastric metastases, an uncommon finding, in a large group of patients with renal cell carcinoma (RCC). We systematically searched the computerized RCC database of our institute, covering 2082 patients (1180 men and 902 women) who had surgery between January 1984 and September 2005, to identify those with a synchronous and/or metachronous diagnosis of cancer in gastric biopsies or resection specimens. The histopathological slides of both renal and gastric cancer probes, and the clinical presentation, treatment and outcome of affected patients, were reassessed. Twelve patients with primary gastric cancer, one with local RCC recurrence affecting the antrum and five with clear cell RCC (three men and two women; mean age 73 years, range 65-83) with haematogenous cancer spread to the stomach were detected. The mean (range) time to gastric metastasis was 6.9 (1.7-13.1) years. There were metastases to other organs, most often the lung, in all patients. Three patients presented with symptoms of gastrointestinal bleeding, which was successfully controlled by local endoscopic therapy. Four patients died from disease at 3-19 months after diagnosis. One patient is still alive with disease after approximately 2 years. Gastric metastasis in patients with RCC appears to be a late event in the course of the disease. Most patients show concomitant tumour spread to other organs, and the outcome is generally poor. The use of targeted drugs might offer a new perspective for affected patients.
              Article 0 comments Cited 24 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): ACG Case Rep J
                Journal ID (iso-abbrev): ACG Case Rep J
                Journal ID (publisher-id): crj
                Title: ACG Case Reports Journal
                Publisher: American College of Gastroenterology
                ISSN (Electronic): 2326-3253
                Publication date Collection: October 2013
                Publication date (Electronic): 08 October 2013
                Volume: 1
                Issue: 1
                Pages: 10-12
                Affiliations
                [1 ]Division of Gastroenterology, University of Alberta, Edmonton, Canada
                [2 ]Division of Anatomical Pathology, University of Alberta, Edmonton, Canada
                Author notes
                Correspondence: Sergio Zepeda-Gómez, MD, Division of Gastroenterology, 1-20A Zeidler Ledcor Centre, 130 University Campus, University of Alberta, Edmonton, Canada T6G2X8 ( zepedago@ 123456ualberta.ca )
                Article
                Publisher ID: crj.2013.6
                DOI: 10.14309/crj.2013.6
                PMC ID: 4435268
                PubMed ID: 26157808
                SO-VID: ccb01e1e-f19e-4530-9b20-39b2ec1b2d7b
                Copyright © Copyright © Chibbar et al.
                License:

                This is an open-access article. This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by-nc-nd/3.0

                History
                Date received : 18 July 2013
                Date accepted : 19 September 2013
                Categories
                Subject: Case Report
                Subject: Endoscopy

                Data availability:

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