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Revista Española de Enfermedades Digestivas

Print version ISSN 1130-0108

Rev. esp. enferm. dig. vol.103 n.12 Madrid Dec. 2011

http://dx.doi.org/10.4321/S1130-01082011001200014 

LETTERS TO THE EDITOR

 

Gastric metastasis from renal cancer six years after nephrectomy

Metástasis gástrica de cáncer renal 6 años tras nefrectomía

 


Key words: Renal cell carcinoma. Gastric metastasis.

Palabras clave: Carcinoma de células renales. Metástasis gástrica.


 

Dear Editor,

Renal cell carcinoma is the third most common urogenital neoplasia (1). The lung and bone tissues represent the most frequent metastatic sites of renal cell carcinoma (2). Metastases in the stomach are rare and have been essentially described during autopsies (3). In this paper, we present a case of large metastatic gastric tumor whose origin was a renal cell carcinoma treated years ago.

 

Case Report

A 56 year old woman was diagnosed with stage one renal adenocarcinoma 6 years ago. She was treated with right radical nephrectomy and adjuvant chemotherapy. Three years later was diagnosed and treated of brain metastasis located in the frontal lobe, as well as in lung. A year ago, she came to our hospital for upper gastrointestinal bleeding. She presented acceptable general condition and nutritional, blood pressure 120/70 mmHg and normal cardio-respiratory auscultation. The abdomen was soft, non-tender, and no masses or organ enlargements. The analytical study revealed 6.3 g/dl hemoglobin. A thoracic abdominal TAC showed a large mass in the body and antrum stomach of 11 cm diameter without invasion adjacent structures. An upper gastrointestinal endoscopy revealed a large neoplasm from body to gastric antrum with mamelonated aspect. The patient underwent subtotal gastrectomy. The postoperative course was uneventful. The pathology and immunohistochemical study showed metastasis of kidney carcinoma (Fig. 1).

 

Discussion

Metastatic gastric cancer is uncommon. The most frequent location sites of cancer cells are in the body and gastric fundus, and single tumors predominate against multiple. Although generally gastric metastases account for 0.2-0.7% of stomach tumors, the metastatic tumor from carcinoma renal cells is extremely rare (3) and is an event late. The gastric metastases from renal cell carcinoma are diagnosed years after the primary tumor (4). The histological diagnoses require immunohistochemical analysis for differential diagnostic. We studied AE1/AE3 and vimentin markers, and the most recent CD10 and renal cell carcinoma markers (RCC-Ma). CD10 is a cell surface enzyme expressed in several types of normal cells including the brush border of renal tubular epithelial cells. Positivity for this marker is seen in more than 90% of renal clear carcinomas (5). RCC-Ma is a monoclonal antibody against a normal renal proximal tubule antigen. RCC-Ma expression is relatively specific for primary clear cell in renal carcinoma (6). In our case, the markers confirmed the diagnosis of renal carcinoma. The classic vimentin and AE1/AE3 markers were strongly positive, while CD10 and RCC-Ma showed moderately and weakly positive staining, respectively. The treatment of gastric metastases is controversial. The patients have poor prognosis with frequent extragastric metastases, and the treatment is endoscopic therapy and arterial embolization (7,8). The absence of evidence for other metastases and the presence of large tumor did not support the consideration of therapeutic endoscopy. By contrast, subtotal gastrectomy allowed acceptable clinical and histological outcome. In summary, although the gastric metastasis of renal carcinoma is rare and occurs late in life, should be investigated systematically during management of these patients.

 

Adolfo Cruz1, Luz María Ramírez2, Eugenia Sánchez3,
Miguel Ruiz1, Isidro Moreno1, Javier López1, Francisco Sánchez1,
Ma Mar de Luna1, Jordi Muntané4, Francisco Báez1 y Francisco J. Padillo5

1Department of General Surgery,
2Department of Digestive, and
3Department of Pathology.
Hospital Valle de los Pedroches.
Pozoblanco. Córdoba, Spain.
4Research Unit. Hospital Universitario
Reina Sofía. Córdoba, Spain.
5Department of General Surgery.
Hospital Universitario Virgen del Rocío.
Sevilla, Spain

 

References

1. Jermal A, Siegel R, Ward E, Hao Y, Xu J, Murray T, et al. Cancer statistics 2008. CA Cancer J Clin 2008;58(2):71-96.         [ Links ]

2. Ather MH, Massood N, Siddiqui T. Current management of advanced and metastatic renal cell carcinoma. Urology Journal 2010;7(1):1-9.         [ Links ]

3. Campoli PM, Ejima FH, Cardoso DM. Metastasis cancer to the stomach. Gastric Cancer 2006;9(1):19-25.         [ Links ]

4. Sugasawa H, Ichikura T, Ono S, Ysujimoto H, Hiraki S, Sakamoto N, et al. Isolated gastric metastasis from renal cell carcinoma 19 years after radical nephrectomy. Int J Clin Oncol 2010;15(2):196-200.         [ Links ]

5. Yamamoto D, Hamada Y, Okazaki S, Kawakami K, Kanzaki S, Yamamoto C, et al. Metastasis gastric tumor from renal cell carcinoma. Gastric Cancer 2009;12(3):170-3.         [ Links ]

6. Perna AG, Ostler DA, Ivan D, Lazar AJ, Diwan AH, Prieto VG, et al. Renal cell carcinoma marker (RCC-Ma) is specific for cutaneous metastasis of renal cell carcinoma. J Cutan Pathol 2007;34(5):381-5.         [ Links ]

7. Pollheimer MJ, Hinterleitner TA, Pollheimer VS, Schlemmer A, Langner C. Renal cell carcinoma metastatic to the stomach: single-centre experience and literature review. BJU Int 2008;102(3):315-9.         [ Links ]

8. Blake MA, Owens A, O'Donoghue DP, McErlean DP. Embolotherapy for massive upper gastrointestinal haemorrhage secondary to metastático renal cell carcinoma: report of three cases. Gut 1995;37 (6):835-7.         [ Links ]

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