Case Report
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Sep 26, 2022; 10(27): 9805-9813
Published online Sep 26, 2022. doi: 10.12998/wjcc.v10.i27.9805
Gastric metastasis presenting as submucosa tumors from renal cell carcinoma: A case report
Wen-Guo Chen, Guo-Dong Shan, Hua-Tuo Zhu, Li-Hua Chen, Guo-Qiang Xu
Wen-Guo Chen, Guo-Dong Shan, Hua-Tuo Zhu, Li-Hua Chen, Guo-Qiang Xu, Department of Gastroenterology, The First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310003, Zhejiang Province, China
Author contributions: Chen WG wrote the paper; Shan GD performed the research; Zhu HT collected and analyzed the data; Chen LH was the study supervisor; Xu GQ conceived and designed the study; all the authors approved the final version of the article to be published.
Supported by the Natural Science Foundation of Zhejiang Province, No. LY19H030009 and No. LY20H030010.
Informed consent statement: Written informed consent was provided by the patient prior to treatment. All details that might disclose the identity of the subject were omitted or anonymized.
Conflict-of-interest statement: The authors of this manuscript have no conflicts of interest to disclose.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Guo-Qiang Xu, MD, Chief Doctor, Department of Gastroenterology, The First Affiliated Hospital of Zhejiang University School of Medicine, No. 79, Qingchun Road, Hangzhou 310003, Zhejiang Province, China. 1193065@zju.edu.cn
Received: April 12, 2022
Peer-review started: April 12, 2022
First decision: June 10, 2022
Revised: June 16, 2022
Accepted: August 12, 2022
Article in press: August 12, 2022
Published online: September 26, 2022
Processing time: 157 Days and 2.5 Hours
Abstract
BACKGROUND

Gastric metastasis from renal cell carcinoma (RCC) is an extremely rare clinical entity. Due to an easily neglected RCC history, nonspecific symptoms and under-recognized endoscopic presentation may lead to a potential diagnostic pitfall in daily clinical practice.

CASE SUMMARY

We present a case of metastatic gastric tumors arising from RCC 5 years after radical nephrectomy. Simultaneous, multifocal metastases to the gallbladder, pancreas and soft tissue were observed. One year previously, a solitary submucosal discoid tumor with a central depression was detected in the gastric fundus in a 65-year-old man. Endoscopic ultrasonography (EUS) showed a 1.12 x 0.38 cm lesion originating from the deeper mucosal layers with partially discontinuous submucosa. One year later, the endoscopic findings of the lesion showed various changes. A large lesion of the protruding type (2.5 cm × 2 cm) was found in the fundus at the same location. EUS showed a heterogeneous mass that involved the mucosa and submucosal layer. In addition, two small similar submucosal lesions 0.4-0.6 cm in size were detected. These lesions had a central depression, surface mucosal congestion and thickened vessels. The two adjacent lesions in the fundus were resected by endoscopic submucosal dissection. Based on the postoperative pathological analysis, the patient was diagnosed with gastric metastasis from RCC.

CONCLUSION

Gastric metastasis from RCC should be considered in patients with a history of RCC irrespective of the time interval involved.

Keywords: Gastric metastasis; Renal cell carcinoma; Nephrectomy; Endoscopic ultrasonography; Endoscopic submucosal dissection; Case report

Core Tip: Gastric metastasis from renal cell carcinoma (RCC) is an extremely rare clinical entity that may be missed or misdiagnosed due to lack of knowledge. We present a case of metastatic gastric tumors arising from RCC 5 years after radical nephrectomy. Simultaneous, multifocal metastases to the gallbladder, pancreas and soft tissue were detected. This case highlights the dynamic changes in white light endoscopy and endoscopic ultrasonography, demonstrating the tumors’ growth pattern during the 1-year follow-up. Our diagnostic excision approach using endoscopic submucosal dissection has been rarely reported in this entity.