Renal cell carcinoma metastasizing to duodenum: a rare occurrence
© Bhatia et al; licensee BioMed Central Ltd. 2006
Received: 28 August 2006
Accepted: 14 September 2006
Published: 14 September 2006
Duodenal metastasis is rare in renal cell carcinoma (RCC) and early detection, especially in case of a solitary mass, helps in planning further therapy.
We present the case report of a 55 year old male with duodenal metastasis of RCC. This patient presented with jaundice and abdominal lump one year after nephrectomy. On upper gastrointestinal endoscopy a submucosal mass lesion was noted in the duodenum, the biopsy of which revealed metastasis.
In a nephrectomized patient presenting with jaundice and an abdominal mass, the possibility of metastasis should be suspected and a complete evaluation, especially endoscopic examination followed by biopsy, should be carried out.
Previously reported examples of duodenal metastasis in patients with renal cell carcinoma
Other organs involved
Lawson et al 
Alive (8 months FU)
Tolia et al 
Heymann et al 
McNichols et al 
Lynch et al 
Alive (6 months FU)
Lost to FU
Robertson et 
Gastaca et al 
Toh et al 
Alive (6 months FU)
Ohmura et al 
Embolization- local resection
Hashimoto et al 
Nabi et al 
Sawh et al 
Brain Anal canal
Alive (4 years FU)
Loualidi et al 
Chang et al 
George et al 
Bhatia et al (current)
Lost to FU
Report of a case
Small bowel involvement by metastatic tumors is rare and has been reported in only 2% of autopsy cases . Common metastatic malignancies known to involve the small bowel are melanomas, lung cancer, carcinoma of the cervix, RCC, thyroid carcinoma, hepatoma and merkel cell carcinoma. Males are more commonly affected (male: female = 1.5:1) and the incidence of metastasis increases with age . Metastatic lesions of the duodenum are most frequently located in the periampullary region or the duodenal bulb . On endoscopy the lesion can be seen as a submucosal mass with ulceration of the tip, multiple nodules of varying sizes or raised plaques . In the present case the metastatic lesion was seen as a 4 × 4 cm submucosal mass in the 2nd part of duodenum. The patients commonly present with gastrointestinal bleeding or intestinal obstruction [10, 17], however our patient presented with jaundice and abdominal lump. On investigation he was found to have liver metastasis also.
The majority of patients are found to have metastasis within a year after nephrectomy though it can be seen even after several years . The routes of spread can be (i) peritoneal dissemination, (ii) direct spread from an intra-abdominal malignancy, (iii) hematogenous and (iv) lymphatic spread . The last two mechanisms can be responsible for metastases in the case reported.
Treatment options in a case of RCC metastasis depend upon the extent and location of the lesion. In the majority of reported cases of duodenal metastasis, metastatectomy was done. However for disseminated malignancy like in our case treatment is in the form of palliative (non-curative) surgery, radiotherapy, chemotherapy (Sunitinib) or immune stimulating agents (Interleukin-2). However even after treatment the patients with metastatic disease have poor survival. The average survival is about 4 months and only 10% of these survive for one year .
The report therefore highlights the importance of investigating patients of RCC presenting with any gastro-intestinal tract manifestations for metastasis. A complete evaluation, especially endoscopic examination and biopsy, should be carried out in such patients. Awareness of this entity and a high index of suspicion on the part of the treating physician and pathologist would help in proper diagnosis and treatment.
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