An obscure cause of gastrointestinal bleeding: Renal cell carcinoma metastasis to the small bowel.
Renal cell carcinoma metastasis to the small intestine is a rare condition. It usually results in gastrointestinal bleeding and it could happen many years after the diagnosis with renal cell cancer. Treatment includes surgery as well as targeted agents such as tyrosine kinases. We report here the case of an 82-year-old man with a past medical history of high-grade renal cell carcinoma and right nephrectomy 6 years earlier, who presented with recurrent episodes of syncope and black stools. He underwent esophagogastroduodenoscopy (EGD) and colonoscopy without evident source of bleeding. Video capsule endoscopy (VCE) showed three bleeding lesions in the jejunum and ileum. Push enteroscopy revealed a proximal jejunum bleeding mass that was suspicious for malignancy. Histopathology demonstrated poorly differentiated carcinoma. Given the patient's history of high-grade renal cell carcinoma, and similarity of histologic changes to the old renal cell cancer specimen, metastatic renal cell carcinoma was felt to be the responsible etiology.
Medical College of Wisconsin, 8701 W Watertown Plank Rd., Milwaukee, WI 53226, USA. Electronic address: rgorski@carolinas.vcom.edu.
Robyn L
RL
Gorski
General Surgery Department, Najah National University Hospital Aseera Street, Nablus, West Bank, Palestine. Electronic address: salah.abdeljalil@najah.edu.
Salah Abdel
SA
Jalil
Pee Dee Gastroenterology, 619 S Dargan St.,Florence, SC 29506, USA. Electronic address: mrazick2@yahoo.com.
Manver
M
Razick
Department of Internal Medicine, McLeod Regional Medical Center, 555 E. Cheves St, Florence, SC 29506, USA; Department of Internal Medicine, Edward Via College of Osteopathic Medicine, Carolinas Campus, 350 Howard Street, Spartanburg, SC 29303, USA. Electronic address: ala79md@yahoo.com.
Ala' Abdel
AA
Jalil
Bleeding; Metastases; Push enteroscopy; Renal cell carcinoma; Small bowel; Video capsule endoscopy